Increased postoperative cervical myelopathy and cord compression resulting from the use of Gelfoam.
BACKGROUND
The immunogenicity of Gelfoam (Pharmacia and Upjohn, Kalamazoo, MI) or microfibrillar collagen, applied during laminectomy, may promote postoperative swelling and significant neural compression.


OBJECTIVE
To document how Gelfoam contributes to marked cord/root compression on unenhanced/enhanced postoperative magnetic resonance (MR) scans.


METHODS
This is a case report from the United States.


METHODS
A case report.


METHODS
The patient's neurological status was assessed using Nurick Grades.


METHODS
A 73-year-old female with moderate myeloradiculopathy (Nurick Grade III) and MR/computed tomography (CT)-documented cord compression underwent a C6/C7 laminectomy (undercutting of C5-T1) with Gelfoam applied to the laminectomy site, followed by a C2-T2 fusion for instability (iliac autograft, Beta TriCalcium Phosphate).


RESULTS
The patient improved for the first postoperative week (Nurick Grade 0-I), but deteriorated over the successive second and third postoperative weeks (Nurick Grade III). When the 3-week postoperative MR study documented marked dorsolateral cord compression at the laminectomy site, likely attributed to a postoperative seroma/hematoma, a second operation was performed. At surgery, no significant seroma/hematoma was found. Rather, markedly engorged Gelfoam densely adherent to and compressing the underlying dura was encountered; this was meticulously removed under the operating microscope using a small nerve hook. Postoperatively, the patient immediately improved. As the intraoperative culture revealed Acinetobacter baumannii, she required 6 weeks of intravenous Ertapenem (1-betamethyl-carbapenem). The MR scan performed on the third postoperative week revealed no residual cord compromise.


CONCLUSIONS
Delayed postoperative deterioration in a 73-year-old female was attributed to reactive swelling/engorgement of Gelfoam at the C6-C7 laminectomy site.
Epstein
Nancy E
NE
The Albert Einstein College of Medicine, Bronx, NY, USA. dch3@columbia.edu
Silvergleid
Richard S
RS
Hollingsworth
Renee
R
D000151:Acinetobacter Infections / Q000188:drug therapy; D040981:Acinetobacter baumannii; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae; D019299:Decompression, Surgical / Q000009:adverse effects / Q000295:instrumentation; D000077727:Ertapenem; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000009:adverse effects*; D006490:Hemostatics / Q000009:adverse effects*; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D013117:Spinal Cord Compression / Q000209:etiology* / Q000473:pathology; D047090:beta-Lactams / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D006490:Hemostatics; D047090:beta-Lactams; D000077727:Ertapenem