Increased postoperative cervical myelopathy and cord compression resulting from the use of Gelfoam.

BACKGROUND CONTEXT: The immunogenicity of Gelfoam (Pharmacia and Upjohn, Kalamazoo, MI) or microfibrillar collagen, applied during laminectomy, may promote postoperative swelling and significant neural compression.

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

STUDY DESIGN/

SETTING

This is a case report from the United States.

PATIENT SAMPLE: A case report.

OUTCOME MEASURE: 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.