Postoperative radiculopathy following the use of a flowable gelatin-based hemostatic matrix in endoscopic lumbar spine surgery: two case reports of uniportal and biportal decompression procedures.

BACKGROUND: Hemostatic matrices such as SURGIFLO are widely used in spine surgery because they provide rapid and effective hemostasis. Although these agents are generally considered safe, rare cases of postoperative neural compression secondary to their expansion have been reported in open spine surgery, but such complications in endoscopic lumbar decompression procedures remain poorly described. We report two cases of delayed postoperative radiculopathy associated with expanded SURGIFLO following uniportal and biportal endoscopic lumbar decompression. CASE DESCRIPTION: Case 1 involved a 61-year-old woman with severe L4-L5 lumbar spinal stenosis who underwent biportal endoscopic unilateral laminotomy for bilateral decompression (ULBD) and was discharged home the same day with improvement of her symptoms. Seven days postoperatively, she developed progressive bilateral lower extremity pain and impaired mobilization. The magnetic resonance imaging demonstrated a compressive epidural collection at L4-L5. Surgical exploration revealed that the expanded hemostatic matrix caused compression of the dural sac and nerve roots. Endoscopic removal of the material resulted in complete neurologic recovery. Case 2 involved an 82-year-old man with single level L4-L5 symptomatic lumbar stenosis who underwent uniportal endoscopic ULBD. One month postoperatively, he presented severe recurrent lumbar radiculopathy and inability to ambulate. Revision surgery demonstrated the expanded gelatin matrix compressing the neural structures. Removal of the compressive material led to symptom resolution. CONCLUSIONS: These cases demonstrate that postoperative expansion of SURGIFLO may cause delayed neural compression following endoscopic decompression. We recommend using a minimal amount of such agent and washing it out once hemostasis is achieved. Endoscopic revision seems to be a safe approach to remove compressive SURGIFLO to resolve the postoperative radiculopathy.