Cauda equina syndrome caused by retained hemostatic agents
Matthew C Bessette1, Addisu Mesfin1
1Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA.
Summary
Retained hemostatic agents like Surgicel and Gelfoam after spinal surgery can cause cauda equina syndrome. Surgical removal of these agents led to partial recovery of neurological function in a patient.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Neurology
Background:
- Hemostatic agents are widely used in spinal surgery to control bleeding.
- Complications from retained hemostatic agents are rarely reported.
- Cauda equina syndrome can result from space-occupying lesions in the spinal canal.
Observation:
- A patient undergoing lumbar microdiscectomy experienced a decline in neurological function post-operatively.
- Pre-existing motor deficits were noted prior to the surgery.
- Reoperation revealed retained Surgicel and Gelfoam causing spinal canal compression.
Findings:
- Retained hemostatic agents (Surgicel, Gelfoam) acted as space-occupying lesions.
- Neurological compromise, including cauda equina syndrome, was secondary to this compression.
- Partial improvement in subjective and objective neurological symptoms was observed after removal.
Implications:
- Highlights a rare but serious complication of commonly used hemostatic agents in spinal surgery.
- Emphasizes the importance of complete removal of hemostatic materials to prevent neurological compromise.
- Suggests vigilance for retained surgical materials in patients with unexplained postoperative neurological decline.
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