Journal List > J Korean Soc Spine Surg > v.18(4) > 1075955

Lee, Kang, and Kim: Gelfoam Granuloma Formation and Myelopathy after Posterior Decompression in Thoracic Spine - A Case Report -

Abstract

Study design

A case report.

Objectives

To document that Gelfoam®(Pharmacia & Upjohn, Kalamazoo, MI) contributes to granuloma formation and spinal cord irritation by immune response.

Summary of Literature Review

The Gelfoam® or microfibrillar collagen applied during various operation for hemostasis. Some complications of Gelfoam®, such as mechanical cord compression, postoperative swelling and mass effect in closed cavity have been reported.

Materials and Methods

The patient was underwent posterior decompression and instrumented posterolateral fusion under the diagnosis of the ossification of ligamentum flavum at T10-11 and T11-12. In operation, Gelfoam® was used at epidural space. She complained of sensory deterioration and muscle weakness around lower extremities after 10days postoperatively. A second operation was performed.

Results

Postoperatively, the patient immediately improved motor grade except spasticity. She is under observation.

Conclusion

Gelfoam® at epidural space after posterior decompression can result hyperactive immune reaction and irritate spinal cord.

REFERENCES

1. Harris WH, Crothers OD, Moyen BJ. Topical hemostatic agents for bone bleeding in humans. A quantitative comparison of gelatin paste, gelatin sponge plus bovine thrombin, and microfibrillar collagen. J Bone Joint Surg Am. 1978; 60:454–6.
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Fig 1.
Magnetic resonance imaging showing epidural tumor compressing thoracic spinal cord. (A) T-2 weighted saggital images showing OLF compressing thoracic spinal cord. (B) T-2 weighted axial images showing OLF compressing thoracic spinal cord.
jkss-18-268f1.tif
Fig 2.
Immediate postoperative x-rays after posterior decompression and instrumented posterolateral fusion. (A) AP view. (B) Lateral view.
jkss-18-268f2.tif
Fig 3.
Magnetic resonance imaging showing epidural Gelfoam® mildly compressing thoracic spinal cord. (A) T-2 weighted saggital and axial images showing Gelfoam® on the thoracic spinal cord. (B) T-1 weighted saggital and axial images showing Gelfoam mildly compressing thoracic spinal cord.
jkss-18-268f3.tif
Fig 4.
Gross photographs. Hardened and thickened Gelfoam® adhesive to dura mata was found and removed.
jkss-18-268f4.tif
Fig 5.
Microscopic photographs. Grauloma formation. Gelfoam® was destructed by polynucleated giant cell and infiltrated by lymphocyte. (A) H&E stain, original magnification ×100. (B) H&E stain, original magnification ×400.
jkss-18-268f5.tif
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