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Dr.,
In October of 2011, a family member had surgery for cervical spinal stenosis. He was only able to walk with a walker
Subsequent surgery in January of 2012, family member underwent a second surgery for spinal stenosis. Family member had complications, e.g. hematoma
Twenty four hours later he underwent a third surgery for removal of the hematoma, gelfoam and scar tissue. Would the scar tissue have contributed to him being a quad? And, if the scar tissue was their with the second surgery could this have been removed. Could the compression have been caused by suturing over scar tissue instead of removing it. Or, possibly a combination of the hematoma, gelfoam, and scar tissue. Thank you.
I assume this family member was only able to walk with a walker before the first surgery due to the stenosis and myelopathy. I am unclear if this same family member then need a second surgery for further decompression or was this another family member? Was the first or second surgery performed from the front or the back of the spine?
It sounds like this same family member developed a hematoma (blood collection) that then caused severe stenosis due to the increased pressure that developed. Did this pressure cause quadriparesis (paralysis)?
Normally, there is scar tissue if the same area had previous surgery. A revision surgery has to accommodate this scar tissue. Gelfoam is uniformly used to coat the dural mater (he covering of the spinal cord) to prevent bleeding as gelfoam substance induces clot formation. There are rare times that Gelfoam along with blood pooling can cause pressure in an enclosed place like the back to the neck.
This is why a drain is used after surgery. Any additional pressure from this blood collection will drain out of the temporary tube in the back of the neck. If for some reason, the drain is clogged then the blood will not drain out and can cause undo pressure on the spinal cord. There can be late formation of fluid (blood or seroma) that can cause pressure in a delayed fashion but this does not seem to be present in these circumstances as the revision surgery was performed within 24 hours when the drain should have been in.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Dr.,
Yes, that is correct the family member was only able to use a walker prior to the first surgery. Yes, this same family member needed a second surgery for further decompression. Both surgeries were posterior (back of the spine). The third surgery was to remove the hematoma, etc. Yes, the family member is now a quad.There are conflicting stories. The resident MD stated the paralysis stemmed from the scar tissue. However, not ever one is in agreement with this position in that the MRI indicated there was a hematoma and a hematoma was removed, along with scar tissue and gelfoam.
With the gelfoam, I have read about the complications, but the pathology reported the gelfoam was removed, with no further description. And, if there was bleeding and the gelfoam was acting like a “sponge”, I can see the pressure to the spine.
With the drains, this is a good response, yet perplexing. I would have thought the same thing, but the notes had indicated the suture dressing along with ABD pads were saturated with blood. Also, if there was a hematoma from cervical to thoracic area where is this blood coming from if it should have been eliminated through the drains? Could this have been from the Heparin the family member was on (was not d/c until the night before surgery)?
Thank you,
SueDrains do not always operate as desired. Blood coagulates (clots) and can clog up the drain. The amount of blood on the dressing indicates that the drain probably did not work well and the pressure of the blood found its way out of the incision.
Gelfoam is almost always placed on the dural after a decompression to “pad” the dura. Dura is fragile and this padding is used to protect it from rough bone surfaces that could puncture it.
Heparin is generally a 24 hour drug so if your family member was taken off 24 hours before surgery, then most likely, the heparin ran its course.
The fact that your family member was walker dependent means that there was already significant compression and dysfunction of the cord prior to surgery. It could have been the hematoma that threw the cord over the edge or just the decompression and manipulation of the cord that caused malfunction.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Dr.,
Thank you very much. Your answers have been very helpful.
Sue
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