Oxidized Cellulose (Surgicel) Causing Postoperative Cauda Equine Syndrome (2024)

FAQs

What are the postoperative complications of cauda equina syndrome? ›

These include urinary dysfunction with retention, loss of sensation around the perineum, buttocks and genitals, and back/leg pain. If a patient has undergone spinal surgery or has had an epidural and develops these symptoms shortly afterwards, medical practitioners should immediately suspect cauda equina syndrome.

Oxidized cellulose (OC) is frequently used to stop bleeding in spine surgery and to pack cavities or lytic defects. OC causes necrosis and swells up to form a gelatinous matrix, hastening clot formation [1].

Surgicel is a resorbable oxidized cellulose material in a sterile fabric meshwork. When Surgicel is applied to the bleeding area, it swells into a brownish/black gelatinous mass that aids in the clotting process.

Surgical Decompression

Cauda equina syndrome is best treated with decompression by a lumbar laminectomy, but a lumbar microdiscectomy may be used given a patient's unique situation. The patient will likely be kept in the hospital for a few days following the surgery to monitor recovery of motor and sensory function.

Cauda equina syndrome

weakness or numbness in both legs that is severe or getting worse. numbness around or under your genitals, or around your anus.

If patients with cauda equina syndrome do not receive immediate, appropriate treatment to relieve the pressure, it can result in permanent paralysis, impaired bladder and/or bowel control, loss of sexual sensation, and other problems.

Pain, numbness, and paralysis have been reported.

When saturated the oxidised cellulose swells into a gelatinous mass. Oxidised cellulose is naturally acidic and it is this acid that starts to break down the blood cells triggering the clotting process in the body. The oxidised cellulose also lowers the pH within the wound due to its acidity.

It must always be removed from the site of application when used in, around, or in proximity to foramina in bone, areas of bony confine, the spinal cord, and/or the optic nerve and chiasm, and in proximity to tubular structures that could become constricted by swelling, regardless of the type of surgical procedure ...

Oxidized regenerated cellulose (ORC), for example Surgicel^® (brand name USA) or, respectively, its European equivalent Tabotamp^® (brand name EU), is often used in neurosurgery to handle small vessel bleeding and oozing [5].

What brand is oxidized regenerated cellulose? ›

Pahacel® Absorbable Hemostat (Oxidized Regenerated Cellulose) is used adjunctively in surgical procedures to assist in the control of capillary, venous and small arterial hemorrhage when ligation or other conventional methods of control are impractical or ineffective.

Oxidized cellulose (Surgicel; Johnson & Johnson, New Brunswick, NJ) is widely used to control bleeding in almost all fields of surgery. It is generally completely absorbed within 6 weeks.

Recovering from cauda equina syndrome

Once the body has recovered from surgery, it will be a matter of time before the nerves are restored. This can take years to achieve, and generally speaking medical experts say that symptoms will improve for up to two years after decompression surgery.

Recovery From Cauda Equina Syndrome

Most medical experts say that gradual recovery can continue for up to two years following surgery. After that period has passed, most doctors say that it is unlikely that there will be much further improvement in a patient's condition.

In some cases, nerve damage can be permanent, and patients need assistance or adaptive devices for daily living. With prompt follow-up and treatment from experienced New Jersey neurosurgeons, most people with cauda equina syndrome are able to recover significant function in the legs and lower body.

CES has also been misdiagnosed as Fibromyalgia (which affects the muscles, ligaments or tendons) or a urinary tract infection. Arachnoiditis is another condition that is often commonly diagnosed when Cauda Equine Syndrome is the true cause of the patient's symptoms.

Cauda equina syndrome in itself is a rare entity and to get it twice is rarer, though not impossible. Patients who are predisposed to cauda equina syndrome like those with malignancy or metastasis or those with blood disorder and are on anticoagulants may rarely have cauda equina syndrome twice too.

The most commonly reported outcomes were bladder function (70.5%), motor function (63.9%), and sensation (50.8%).

Cauda equina syndrome itself is not a permanent disability. However, if a person who develops cauda equina syndrome does not get prompt treatment at the key time, then they can be left with permanent disabilities. These can range from ongoing pain to bladder and bowel control problems or paralysis.

Cauda equina syndrome (CES) is a potentially devastating event resulting in life-changing long-term neurological disability.

How many times can you get cauda equina? ›

It is possible to get cauda equina syndrome more than once. If you think your cauda equina syndrome has returned, you need to seek urgent medical help.

Regenerated cellulose

Cellulose is soluble in several kinds of media, several of which are the basis of commercial technologies. These dissolution processes are reversible and are used in the production of regenerated celluloses (such as viscose and cellophane) from dissolving pulp.

Oxidative stress can damage cells, proteins, and DNA, which can contribute to aging. It may also play a role in development of a range of health conditions, including diabetes, cancer, and neurodegenerative diseases such as Alzheimer's.

Although the mechanism of action is not fully understood, oxidized cellulose forms a gelatinous mass when saturated with blood. It acts as a matrix for fibrin deposition, promoting platelet plug formation and aiding surgical hemostasis. It also causes local vasoconstriction, further controlling intraoperative bleeding.

When a substance is oxidized, it loses electrons. In chemical reactions, this requires that another substance take on those electrons and be reduced. Therefore, when a substance undergoes oxidation, it causes another substance to be reduced.

Consuming cellulose from foods, supplements, or additives is likely safe for most people. However, getting too much of it may lead to side effects that happen with the overconsumption of fiber, such as gas, bloating, and stomach pain.

In this process, cellulose is first transformed to unstable, “active” cellulose that further decomposes so that reaction products are mainly carbon dioxide and water, and the “backbone” of cellulose containing a lot of carbon (see Figure 2c). Figure 2. a) The two main reaction pathways of thermal decomposition of wood.

The hemostatic action of surgicel is by formation of a gelatinous mass upon saturation with blood, which leads to formation of a stable clot.

The dressing may be left in place for up to 24 hours. Gently remove dressing. If the dressing is difficult to remove, hydrate with sterile saline. At the end of the procedure, thoroughly irrigate the wound to remove kaolin that may be released from the dressing.

The original dressing can be left in place for up to two days (or as advised by the nurse/doctor), as long as it is not oozing. The wound must be kept dry for two days. If the dressing becomes wet from blood or any other liquid, it must be changed.

Is oxidised cellulose an absorbable hemostat? ›

Oxidized cellulose consists of a polyanhydroglucuronic acid and is manufactured from wood pulp, and the precise mechanism of its hemostatic response is unidentified. It is mostly applied in the surgical setting because it is absorbable and is able to leave in the body cavities.

Oxidized regenerated cellulose (ORC) is a commonly used absorbable hemostatic product that prevents bleeding and controls epidural oozing [2]. In a comprehensive review of topical hemostatic agents, ORC showed only moderate hemostatic effects, but good handling properties [3].

Polysaccharides are carbohydrates made up of multiple saccharide units. Some of them serve as energy fuel (e.g. starch and glycogen) whereas others have structural functions (e.g. cellulose). It is the fibrous carbohydrate found in the cell walls of green plants, some algae, and oomycetes.

Cellulose Acetate is a specific type of polymer used for low protein binding applications. Regenerated cellulose, on the other hand, is a pure cellulose which has been treated in a chemical bath for better chemical resistance.

Oxidized Regenerated Cellulose Surgical Fibrillar Ethicon, Packaging Type: Box, Size: 2in X 4in at Rs 30000/box in New Delhi.

Viscose rayon and acetate, which were amongst the first regenerated cellulose fibres, exhibited tenacities below 0.2 N/tex. The need to improve the strength of cellulosic fibres led to the development of continuous-filament rayon yarns (Tenasco), with a tenacity of 0.4 N/tex, which were used for tyre cords.

Oxidized regenerated cellulose is a chemically altered form of cellulose, which is particularly useful to control diffuse bleeding from broad surfaces. Surgicel has mechanical hemostatic effects as a result of swelling from blood absorption, and it activates coagulation on the collagen surface.

If SURGICEL^® Absorbable Hemostat is used temporarily to line the cavity of large open wounds, it should be placed so as not to overlap the skin edges. It should also be removed from open wounds by forceps or by irrigation with sterile water or saline solution after bleeding has stopped.

Headache, burning, stinging, and sneezing in epistaxis and other rhinological procedures, and stinging when SURGICEL® product was applied on surface wounds (varicose ulcerations, dermabrasions, and donor sites) have also been reported.

Left untreated, CES can result in permanent paralysis and incontinence. Those experiencing any of the red flag symptoms should be evaluated by a neurosurgeon or orthopedic spine surgeon as soon as possible. Prompt surgery is the best treatment for patients with CES.

Can cauda equina nerves regenerate? ›

The nerve cells will be able to regenerate, and while this may take up to a year or more, a patient can go on to regain full function once again. Some people may even notice an improvement in symptoms immediately after surgery.

Cauda Equina Syndrome (CES) is a rare condition, occurring in one to three in every 100,000 people. The cauda equina is formed by nerve roots in the lower back. CES is caused by compression of the nerves.

Unfortunately, there are some individuals that may find the feeling in their saddle area does not improve fully or at all. If surgery is received before an individual suffers from complete saddle anaesthesia, there is a better chance that the individual may recover some or all of the feeling in the saddle area.

Nerves heal about one inch per month. You'll have follow-up appointments with your surgeon, during which he determines how your nerve regeneration is progressing. Nerve fibers have to grow down the full length of the damaged nerve to where the nerve and muscle intersect. That can take between six months to one year.

The defined incomplete cauda equina syndrome as "a patient with urinary difficulties, altered urinary sensation, loss of desire to void, poor urinary stream, and the need to strain to [urinate]." On the other hand, complete cauda equina syndrome was "painless urinary retention and overflow incontinence."

Cauda Equina Syndrome Recovery at Home

Recovering from a spinal decompression procedure such as lumbar laminectomy or discectomy can take about four to six weeks. This timeline depends on individual health factors such as age, general health and the cause of the compression.

Recurrent cauda equina syndrome

As long as this treatment is provided without delay, there is no reason why a patient should not go on to make a good recovery. However, this is a small risk that the cauda equina syndrome will return – often due to another prolapsed or sequestered disc.

Walking will be painful, while the neurological injury will affect function, meaning the legs and feet cannot work as they did before. The foot drop may cause the feet to drag along the floor, and the numbness will create a strange sensation that makes it hard to walk naturally.

The most common are postdural puncture headache and hypotension. Hypotension after spinal anesthesia is a physiological consequence of sympathetic blockade.

What is most feared dreaded complication of spinal anaesthesia? ›

11. Cardiac arrest and perioperative death. Bradycardia and cardiac arrest are the most worrisome complications related to spinal anaesthesia.

Subdural hematoma following spinal anesthesia is a rare but potentially fatal condition (3).

The most commonly reported outcomes were bladder function (70.5%), motor function (63.9%), and sensation (50.8%).

If Cauda Equina Syndrome remains untreated for too long, the damage to the nerves will be extensive – in fact, it will be so severe that repair is simply not possible, and any treatment will be ineffective.

Cauda equina syndrome in itself is a rare entity and to get it twice is rarer, though not impossible. Patients who are predisposed to cauda equina syndrome like those with malignancy or metastasis or those with blood disorder and are on anticoagulants may rarely have cauda equina syndrome twice too.

Cauda equina syndrome (CES) is a potentially devastating event resulting in life-changing long-term neurological disability.

Pelvic floor exercises can assist with regaining bladder control and gentle aerobic exercise such as walking can help restore strength in the lower back and legs.

The nerve cells will be able to regenerate, and while this may take up to a year or more, a patient can go on to regain full function once again. Some people may even notice an improvement in symptoms immediately after surgery.

Ambulation and gait training help in improving balance and regaining the patient's confidence which also leads to psychological satisfaction for the patient. All these exercises can be beneficial in planning a rehabilitation protocol for patients with cauda equina syndrome.