Retained surgical sponges, a denied neurosurgical reality? Cautionary note

Abstract

Surgically acquired foreign bodies are well known but not widely reported. Only seven articles pertaining to this subject were found in the current neurosurgical literature. Are they a denied neurosurgical reality? In this report with a concededly provoking title, the authors elucidate clinical and medicolegal aspects of retained surgical sponges, with emphasis on spinal procedures. To highlight particulars, a case is presented in which a retained surgical sponge was encountered as the cause of progressive low back pain and tender swelling in the scar area after instrumented posterolateral lumbar spinal fusion combined with pedicle screw fixation for lumbosacral spondylolisthesis 4 years earlier. However, until today, no reported neurosurgical patient has suffered a serious complication due to a retained surgical sponge. The authors wish to remind the neurosurgical community to learn from unpleasant clinical and medicolegal experiences in other specialties before serious complications occur, and we suggest rigorous standardization of intraoperative habits to avoid this hazardous complication.

Spinal Textiloma (Gossypiboma): A Report of Three Cases Misdiagnosed as Tumour

“…In relation to the recent increase in complex spine surgeries, the number of gauze bandages and pads that are used in such surgeries has also increased (9,10,(12)(13)(14)(15)(16)(17)(18). Among these textile products, surgical sponges are the most commonly used.…”

Sponge-Induced Granuloma ("Gauzoma") as a Complication of Posterior Lumbar Surgery-Case Report-

“…3,7,8,12,16) A case of granulomatous abscess was caused by a forgotten sponge during a laminectomy procedure performed 40 years previously. 14) The predisposing factors for infection after spinal surgical procedures are inadequate sterilization, perioperative cutaneous infection, perioperative contamination, forgotten foreign bodies (sponge, needle, cottonoids etc.…”

“…), corticosteroid drugs, and spinal instrumentation. 2,3,[5][6][7][8][9][10][11][12][13][14][15][16] Treatment of spinal abscess caused by retained surgical sponges consists of early diagnosis, surgical removal, and appropriate antibiotic treatment if necessary. However, we believe that the presence of foreign material as a nidus for infection precludes successful treatment of a spinal infection.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] A review of the literature concerning retained sponge following spinal surgery found only nine reports. 3,5,7,11,12,14,15) The incidence was reported as 0.7 per 10,000 patients but probably underestimates the actual incidence. 12) The management of this complication is critical.…”

Foreign Body Mimicking Sacral Tumour: Gauze Retained After the Lumbar Disc Surgery Performed 31 Years Ago

“…Likewise, the neurosurgery literature includes only a few papers on gossypiboma [6]. Ramirez and Thisted reported 0.7% gossypiboma after 10.000 lumbar disc surgeries [7].…”