J Korean Soc Spine Surg.  2011 Dec;18(4):268-272. 10.4184/jkss.2011.18.4.268.

Gelfoam Granuloma Formation and Myelopathy after Posterior Decompression in Thoracic Spine: A Case Report

• Lee KY
• Kang JH
• Kim HJ

• KMID: 1448007
• DOI: http://doi.org/10.4184/jkss.2011.18.4.268

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
To document that Gelfoam(R) (Pharmacia & Upjohn, Kalamazoo, MI) contributes to granuloma formation and spinal cord irritation by immune response. SUMMARY OF LITERATURE REVIEW: The Gelfoam(R) or microfibrillar collagen applied during various operation for hemostasis. Some complications of Gelfoam(R), 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(R) 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.
CONCLUSIONS
Gelfoam(R) at epidural space after posterior decompression can result hyperactive immune reaction and irritate spinal cord.

Keyword

Gelfoam(R); Immune reaction; Spinal fusion

MeSH Terms

Collagen
Decompression
Epidural Space
Gelatin Sponge, Absorbable
Granuloma
Hemostasis
Humans
Ligamentum Flavum
Lower Extremity
Muscle Spasticity
Muscle Weakness
Spinal Cord
Spinal Cord Diseases
Spinal Fusion
Collagen

Figure

• 

  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.

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  Fig 2. Immediate postoperative x-rays after posterior decompression and instrumented posterolateral fusion. (A) AP view. (B) Lateral view.

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  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.

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  Fig 4. Gross photographs. Hardened and thickened Gelfoam® adhesive to dura mata was found and removed.

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  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.

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