Paraplegia after iatrogenic extrinsic spinal cord compression after descending thoracic aorta repair: case report and literature review

Post-thoracotomy paraplegia after oxidized cellulose spinal compression

Post-thoracotomy paraplegia after non-aortic surgery is an extremely uncommon complication. A 56-year-old woman presented with a 1-year history of progressive shortness of breath. Computed tomography revealed a locally advanced posterior mediastinal mass involving the ribs and the left neural foramina. Tumor excision with a left pneumonectomy was performed. Post-resection, bleeding was noted in the vicinity of the T4-T5 vertebral body, and the bleeding point was packed with oxidized cellulose gauze (Surgicel®). Postoperatively, the patient complained of bilateral leg numbness extending up to the T5 level, with bilateral paraplegia. An urgent laminectomy was performed, and we noted that the spinal cord was compressed by two masses of Surgicel® with blood clots measuring 1.5 × 1.5cm at T4 and T5 levels. The paraplegia did not improve despite the removal of the mass, sufficient decompression, and aggressive postoperative physiotherapy. Surgeons operating in fields close to the intervertebral foramen should be aware of the possible threat to the adjacent spinal canal as helpful hemostatic agents can become a preventable threat.

Tracheal Compression Caused by a Hematoma After Redo Aortic Root Replacement

Postoperative tracheal compression caused by hematoma is extremely rare in patients who have undergone cardiovascular operations. A 65-year-old man underwent elective redo aortic root replacement. Hemostasis was controlled with Surgicel packing (Ethicon, Somerville, NJ). After extubation, he had severe respiratory distress. The emergent computed tomographic scan showed severe obstruction of the tracheal bifurcation compressed by a hematoma around the packed Surgicel. During reexploration, a considerable hematoma was removed. He was extubated 1 day later and recovered to a good condition. In cases of unexplained respiratory failure, tracheal compression by hematoma around packed Surgicel should be considered.

Coincidence of spinal canal stenosis and thoracoabdominal aortic aneurysm

We report a case in which a thoracoabdominal aneurysm was present in association with previously unknown critical spinal canal stenosis. In spite of using left heart bypass, systemic hypothermia, and controlled cerebrospinal fluid drainage for spinal cord protection, the patient developed paraplegia following aortic aneurysm repair. Computed tomography scan revealed critical stenosis of the spinal canal that was thought to be sufficient to produce spinal cord compression syndromes including paraplegia.

Oxidised regenerated cellulose as a cause of paraplegia after thoracotomy: case report and review of the literature

STUDY DESIGN

Case report.

OBJECTIVE

To report an unusual case of paraplegia.

SETTING

University Hospital Bursa, Turkey.

CASE REPORT

A 22-year-old woman presented with paraplegia following a left-sided thoracotomy. Magnetic resonance imaging showed a dorsal epidural mass at the level of T6. The patient underwent an emergency T6/7 laminectomy and removal of a tuft of oxidised regenerated cellulose, which had migrated through the intervertebral foramen causing spinal cord compression.

CONCLUSION

In cases of neurological deficits after surgery at the posterolateral edge of a thoracotomy, the clinician should be aware of the above possibility. Urgent radiological diagnosis and decompressive laminectomy is the treatment of choice.