title: Lumbar cauda equina syndrome associated with the use of gelfoam: case report.
abstract: METHODS
  A case of cauda equina syndrome is reported.
  
  
  OBJECTIVE
  To recognize a serious complication related to the use of Gelfoam in the lumbar spine.
  
  
  BACKGROUND
  Absorbable hemostatic gelatin sponges have long been used to control bleeding around the spinal cord. Despite widespread use and a safe history with few reported adverse reactions, Gelfoam sponges have potential for complications that may be overlooked.
  
  
  METHODS
  A case of cauda equina syndrome is reported and discussed.
  
  
  RESULTS
  A retained Gelfoam sponge was found in the epidural space after lumbar decompression and fusion for spinal stenosis. The retained gelatin sponge had expanded and solidified, causing a mass affect. The resultant nerve compression led to progressive myelopathy. On removal of the Gelfoam, symptoms rapidly resolved.
  
  
  CONCLUSIONS
  Although the use of Gelfoam in spine surgery generally is considered safe, care must be taken to avoid placing a large mass of sponge in a potentially closed space. If Gelfoam is not handled properly, it can engorge and fail to be resorbed appropriately, thus causing a mass effect. If neurologic compromise develops, Gelfoam should be considered a potential cause and subsequently removed.
authors.affiliation: Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA.
authors.forename: J
authors.initials: J
authors.lastname: Friedman
authors.forename: T S
authors.initials: TS
authors.lastname: Whitecloud
mesh_terms: D001863:Bone Screws; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000009:adverse effects*; D006490:Hemostatics / Q000009:adverse effects*; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011128:Polyradiculopathy / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D014057:Tomography, X-Ray Computed
chemical_list: D006490:Hemostatics