Lumbar cauda equina syndrome associated with the use of gelfoam: case report.

STUDY

DESIGN

A case of cauda equina syndrome is reported.

OBJECTIVE

To recognize a serious complication related to the use of Gelfoam in the lumbar spine.

SUMMARY AND BACKGROUND DATA: 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.

METHOD: 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.