Post-thoracotomy paraplegia after oxidized cellulose spinal compression

einstein (São Paulo), 2023 · DOI: 10.31744/einstein_journal/2023RC0078 · Published: March 6, 2023

Simple Explanation

A 56-year-old woman experienced paraplegia (loss of leg function) after undergoing surgery to remove a mediastinal mass. During the surgery, oxidized cellulose gauze (Surgicel®) was used to stop bleeding near her spine. Postoperatively, it was found that the Surgicel® had compressed her spinal cord, leading to the paraplegia. Despite surgery to remove the Surgicel® and relieve the compression, her paraplegia did not improve significantly. This case highlights a rare but serious complication where a hemostatic agent like Surgicel®, used to control bleeding, can inadvertently cause spinal cord compression and subsequent paralysis after thoracotomy.

Study Duration

Not specified

Participants

One 56-year-old woman

Evidence Level

Level 4, Case Report

Key Findings

1
The patient developed bilateral leg numbness and paraplegia postoperatively, extending up to the T5 level.
2
MRI revealed an extradural compressive mass at T4 and T5, which was confirmed during laminectomy to be Surgicel® with blood clots.
3
Despite surgical decompression and physiotherapy, the patient's paraplegia did not significantly improve, indicating the severity of spinal cord injury caused by the compression.

Research Summary

This case report describes a rare instance of post-thoracotomy paraplegia caused by spinal cord compression from oxidized cellulose (Surgicel®) used for hemostasis. The patient, a 56-year-old woman, developed paraplegia after tumor excision, where Surgicel® was packed into the neural foramina to control bleeding. The report emphasizes the importance of awareness and caution when using hemostatic agents near the spinal canal to prevent iatrogenic spinal cord injury.

Practical Implications

Surgical Technique

Meticulous surgical technique and good visualization are crucial to minimize bleeding and avoid excessive use of hemostatic agents near the spinal canal.

Awareness and Suspicion

Surgeons should maintain a high index of suspicion for spinal cord compression in patients presenting with neurological deficits after thoracotomy, especially when hemostatic agents were used.

Prompt Intervention

Early neurological consultation and imaging are essential for timely diagnosis and intervention to improve the chances of neurological recovery.

Study Limitations

1
Single case report limits generalizability.
2
Lack of long-term follow-up to assess the extent of neurological recovery.
3
Specific to oxidized cellulose; other hemostatic agents might present different risks.

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