Effectiveness of Gelatin‐Thrombin Matrix Sealants (Floseal®) on Postoperative Spinal Epidural Hematoma during Single‐Level Lumbar Decompression Using Biportal Endoscopic Spine Surgery: Clinical and Magnetic Resonance Image Study

Abstract

<jats:p><jats:italic>Background</jats:italic>. Symptomatic postoperative spinal epidural hematoma (PSEH) is a devastating complication that could develop after lumbar decompression surgery. PSEH can also develop after biportal endoscopic spine surgery (BESS), one of the recently introduced minimally invasive spine surgery techniques. Gelatin-thrombin matrix sealant (GTMS) is commonly used to prevent PSEH. This study aimed at analyzing the clinical and radiological effects of GTMS use during BESS. <jats:italic>Methods</jats:italic>. A total of 206 patients with spinal stenosis who underwent decompression by BESS through a posterior interlaminar approach from October 2015 to September 2018 were enrolled in this study. Postoperative magnetic resonance imaging (MRI) was performed in all patients for evaluation of PSEH. Patients in whom GTMS was not used during surgery were assigned to Group A, and those in whom GTMS was used were classified as Group B. In the clinical evaluation, the visual analog scale (VAS) of the leg and back, Oswestry Disability Index (ODI), and modified MacNab criteria were used. The incidence rate and degree of dural compression of PSEH on postoperative MRI were measured. <jats:italic>Results</jats:italic>. The average age of the patients was <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mn>68.1</mml:mn><mml:mo>±</mml:mo><mml:mn>11.2</mml:mn></mml:math> (42–89) years. The overall incidence rate of PSEH was 20.9% (43/206). The incidence rates in Groups A and B were 26.4% and 13.6%, respectively, showing a significant difference (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.023</mml:mn></mml:math>). The VAS-leg and ODI improvement was significantly different depending on the intraoperative use of GTMS. However, there was no statistically significant difference between the two groups in terms of the VAS-back improvement. Groups A and B showed “good” and “excellent” rates according to the modified MacNab criteria in 79.4% and 87.6% of patients, respectively, showing statistically significant difference (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.049</mml:mn></mml:math>). In Group A, two patients underwent revision surgery due to PSEH, while none in Group B had such event. <jats:italic>Conclusion</jats:italic>. Intraoperative use of GTMS during BESS may be related to reduction in the occurrence rate of PSEH. Specifically, patients with GTMS appliance showed marked decrease in the occurrence of PSEH and had better clinical outcomes.</jats:p>

Effectiveness of a Gelatin–Thrombin Matrix Sealant (Floseal®) for Reducing Blood Loss During Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis: A Retrospective Cohort Study

“…Kim et al reported that revision surgery for PSEH was performed in 1.0% (2/206) of LSCS cases overall who were treated with biportal endoscopic spine surgery; this rate was not significant, irrespective of whether GTMS was used. 13 Using an MRI study, they reported that the incidence of PSEH in the GTMS-used group (13.5%) was decreased by half compared to that in the nonused group (26.5%). On the other hand, Takami et al reported that the area of hematoma measured by MRI 3 to 5 days after surgery was not significantly different, irrespective of whether GTMS was used prophylactically.…”

Uniportal Full-Endoscopic versus Minimally Invasive Decompression for Lumbar Spinal Stenosis: A Meta-analysis

“…Intraoperative use of the gelatin-thrombin matrix sealant during endoscopic spine surgery may reduce the occurrence rate of PSEH. 54 Besides sufficient hemostasis and used of bone wax and gelatin, placement of wound drainage in MIS surgery is also a good measure to prevent PSEH.…”

Global and Current Research Trends of Unilateral Biportal Endoscopy/Biportal Endoscopic Spinal Surgery in the Treatment of Lumbar Degenerative Diseases: A Bibliometric and Visualization Study

“…Since the start of UBE/BESS technology, the overall number of published studies had shown a steady growth trend, which indicated that UBE/BESS technology research had entered a stage of rapid development and maintained a high degree of heat. As a new surgical technique, UBE/BESS had a short history and less published literature 7,[15][16][17][18] . Literature research showed that only 13 countries and regions had paid attention to it.…”