Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2022; 10(30): 11178-11184
Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.11178
Cauda equina syndrome caused by the application of DuraSealTM in a microlaminectomy surgery: A case report
Kuei-Lin Yeh, Szu-Hsien Wu, Chiou-Shann Fuh, Yi-Hung Huang, Chu-Song Chen, Shing-Sheng Wu
Kuei-Lin Yeh, Yi-Hung Huang, Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan
Kuei-Lin Yeh, Chiou-Shann Fuh, Chu-Song Chen, Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
Kuei-Lin Yeh, Department of Long-Term Care and Management, WuFeng University, Chiayi County 621303, Taiwan
Szu-Hsien Wu, Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11217, Taiwan
Shing-Sheng Wu, Department of Orthopaedics, Shin Kong Wu-Ho Su Memorial Hospital, Taiepi 111, Taiwan
Author contributions: Yeh KL, Wu SH, Fuh CS, Wu SS, and Huang YH contribute to conceptualization; Yeh KL, Chen CS, Fuh CS, and Wu SS contribute to methodology; Yeh KL, Wu SH, Chen CS, and Huang YH contribute to validation; Yeh KL, Huang YH, Wu SS, and Fuh CS contribute to investigation; Wu SH, Chen CS, Fuh CS, and Wu SS contribute to data curation; Yeh KL, Wu SH, Wu SS, Huang YH, and Fuh CS contribute to writing original draft preparation; Yeh KL, Wu SH, Fuh CS, Huang YH, and Wu SS contribute to writing-review and editing; Wu SS and Yeh KL contribute to supervision; all authors have read and agreed to the published version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shing-Sheng Wu, MMed, MSc, Chief Physician, Doctor, Professor, Surgeon, Department of Orthopaedics, Shin Kong Wu-Ho Su Memorial Hospital, No. 95 Wenchang Road, Shilin District, Taiepi 111, Taiwan. raysswu@gmail.com
Received: July 15, 2022
Peer-review started: July 15, 2022
First decision: August 22, 2022
Revised: August 29, 2022
Accepted: September 22, 2022
Article in press: September 22, 2022
Published online: October 26, 2022
Processing time: 97 Days and 12.5 Hours
Abstract
BACKGROUND

The management of dural tears is important. While a massive dura can be repaired with absorbable suture lines, cerebrospinal fluid leakage can be attenuated by dural sealant when an unintended tiny durotomy occurs intraoperatively. DuraSeal is often used because it can expand to seal tears. This case emphasizes the need for caution when DuraSeal is used as high expansion can cause complications following microlaminectomy.

CASE SUMMARY

A 77-year-old woman presented with L2/3 and L3/4 lateral recess stenosis. She underwent microlaminectomy, foraminal decompression, and disk height restoration using an IntraSPINE® device. A tiny incident durotomy occurred intraoperatively and was sealed using DuraSealTM. However, decreased muscle power, urinary incontinence, and absence of anal reflexes were observed postoperatively. Emergent magnetic resonance imaging revealed fluid collection causing thecal sac indentation and central canal compression. Surgical exploration revealed that the gel-like DuraSeal had entrapped the hematoma and, consequently, compressed the thecal sac and nerve roots. While we removed all DuraSealTM and exposed the nerve root, the patient’s neurological function did not recover postoperatively.

CONCLUSION

DuraSeal expansion must not be underestimated. Changes in neurological status require investigation for cauda equina syndrome due to expansion.

Keywords: Cauda equina syndrome; DuraSeal; Microlaminectomy; Spinal stenosis; Case report

Core Tip: The number of laminectomies is increasing, and incidental durotomy sometimes occurs intraoperatively. One of the approaches to manage dural tears was using sealants such as DuraSealTM. We present the case of a 77-year-old patient who suffered from incidental durotomy with treatment of using DuraSealTM when undergoing spine surgery. Postoperative cauda equina syndrome was noted. Surgical exploration revealed thecal sac and nerve roots compression by entrapped hematoma. Our case highlights the potential catastrophic consequences of over-expansion of dural sealant, and demonstrates that cauda equina syndrome should be considered if neurological symptoms develop following application of DuraSealTM.