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

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.

An Effects of Hemostatic Materials on Cranial Bone Osteogenesis in Rabbit

The influence of hemostatic materials in split thickness calvarial bone defects was evaluated in 24 white rabbit models. The rabbits were divided in 4 groups. In the group A, Surgicel(R) was inserted into the 2x2cm sized left calvarial defects. In the group B, Gelfoam(R) was inserted and in group C, Bonewax(R) was inserted and in group D, Collagen bloc was inserted. The contralateral side underwent sham operation as the control group. After 4 and 8 weeks, radiological findings, histopathological findings and immunohistopathological findings were studied to find development of trabeculae, appearance of osteoblast, calcification and increased expression of TGF-beta. As a result, osteoid and osteoblast were richly found in Surgicel(R), Gelfoam(R), Collagen bloc inserted groups. In Bonewax(R) inserted group, bone regeneration was delayed and foreign body reaction was seen in 4 weeks and it reduced in 8 weeks. The TGF-beta was darkly stained in periosteum, connective tissue and periphery of bone defect. From this result it would be concluded as follows. Surgicel(R), Gelfoam(R) and Collagen bloc effects positively on bone healing with marked increasing of osteoid, osteoblasts and rapid bone remodeling. Bonewax(R) prolongs bone healing with increasing foreign body reaction. Bone regeneration was confirmed with increased expression of TGF-beta in Surgicel(R), Gelform(R) and Collagen bloc applied groups especially in periosteum and ends of bone defects. It suggests that bone regeneration was originated from these areas.