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

Abstract

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.