Gelatin sponge as a rare and forgotten cause of early-onset neurological deficit post osteotomy of thoracolumbar kyphosis—A case report and review of literature

INTRODUCTION: Neurological deficits complicating the correction of spinal deformity usually occur acutely during surgery or immediately after surgery. Absorbable gelatin sponges have been used to control bleeding and prevent undesired event during and after spinal surgery since more than 50 years ago. However, its potency of osmotic expansion within an enclosed space containing neural tissue can cause compression of the spinal cord. We presented a rare, early-onset postoperative neurological deficit caused by the use of absorbable gelatin sponge. METHOD: A 27 years old female patient with kyphosis of thoracolumbal vertebrae at the level of Th 10 – L2 presented with neurologic deficit gradually started 24 h after the posterior vertebrae column resection (PVCR), laminectomies, and Smith Peterson (SPO) osteotomy procedure of severe fixed kyphosis correction of deformity in thoracolumbar area. RESULT: Immediate surgical exploration within 24 h was performed with the duration of surgery of 1 h. Hematoma and retained sponge were found within the site of laminectomy, compressing the spinal cord. After removal of gelatin sponge and its associated hematoma, the neurological function returned to normal at 48 h postoperatively. CONCLUSION: The use of absorbable gelatin sponge for controlling bleeding and preventing adhesions in spinal surgery has the potency of spinal cord compression due to expansion within the enclosed space, therefore a large piece of absorbable gelatin sponge should be removed once hemostatic control is achieved and small piece, soaked sponge should be used if the sponge is to be left in place, in order to avoid this complication.