Cauda equina compression by hydrogel dural sealant after a laminotomy and discectomy: case report.
METHODS
The authors present a case of cauda equina compression after laminotomy and discectomy where incidental durotomy was managed with the application of hydrogel sealant. The patient reported return of radicular symptoms on the first postoperative day, and deterioration to early cauda equina syndrome after bending on the sixth day.


OBJECTIVE
To demonstrate that in addition to its recognized volume expansion properties, that the product has the ability to migrate and produce symptoms remote from where it was inserted.


BACKGROUND
The physical properties of DuraSeal (Confluent Surgical, Waltham, MA), a hydrogel dural sealant, make it an effective adjunct to dural closure. Its volume expansion has been associated with neural compression after posterior fossa decompression. We have found no reported migration of this product.


METHODS
Sequential postoperative imaging shows swelling and migration of the hydrogel into spinal canal with resultant compression. Exploration on postoperative day 10 revealed sealant causing cauda equina compression proximal to the site of the durotomy.


CONCLUSIONS
The authors recommend that in addition to caution regarding its potential mass effect, that cognizance be taken of the product's potential to migrate and result in symptoms at a distant site.
Mulder
Mike
M
Department/Division of Orthopaedic Surgery, Princess Alice Orthopaedic unit, Christiaan Barnard Memorial Hospital, Cape Town, South Africa. mike_rosemulder@telkomsa.net
Crosier
J
J
Dunn
R
R
D001843:Bone Cements / Q000009:adverse effects*; D002420:Cauda Equina / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D017586:Diskectomy; D005548:Foreign-Body Migration / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D017116:Low Back Pain / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012117:Resins, Synthetic / Q000009:adverse effects*; D013117:Spinal Cord Compression / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
D001843:Bone Cements; D012117:Resins, Synthetic; C030189:Dura-Seal