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.
A 63-year-old man developed acute cauda equina syndrome due to fat graft compression. Following decompressive laminectomy and posterior instrumented fusion with pedicle screw fixation for spinal stenosis of L5 and S1 vertebral levels, free fat grafting was performed to cover the exposed dura. The patient developed gradual neurological deficit three days postoperatively. This started with sensory loss and weakness of the affected dermatomes and myotomes, followed by bowel incontinence on the 12th postoperative day. Intraoperatively, significant dural compression by the fat graft was confirmed. Immediate removal of the fat graft resulted in recovery from cauda equina syndrome.