Intradural Collection Following Laminectomy: The Potential Role of Fibrin Glue in Remote Hematoma Formation

Introduction: Laminectomy is a common spinal procedure that can be associated with complications such as dural tears and cerebrospinal fluid (CSF) leaks. Fibrin sealants are often used to achieve hemostasis and prevent CSF leaks. However, the migration of these products to remote locations is a rare but potentially significant complication. This case report presents an unusual instance of suspected fibrin glue migration resulting in an intradural collection at a level higher than the initial surgical site.

Methods: We present a case of a 57-year-old female who underwent a minimally invasive L5-S1 laminectomy for abscess removal. The patient's medical history, surgical procedure, postoperative course, and imaging findings were thoroughly reviewed. A literature search was conducted to identify similar cases and potential mechanisms for this complication.

Results: Following surgery, the patient developed new-onset bilateral leg pain and urinary retention. Postoperative MRI revealed a new peripherally enhancing dorsal epidural or subdural collection at the L2 level, significantly higher than the L5-S1 surgical site. This collection caused moderate to severe thecal sac narrowing and compression of the cauda equina nerve roots. The appearance and location of the collection led to the suspicion that it might be related to the Adherus fibrin glue used during the initial surgery. The patient's symptoms gradually improved with conservative management, and follow-up imaging at five weeks showed resolution of the collection.

Conclusion : This case highlights a rare complication of fibrin glue migration following spine surgery, resulting in a remote intradural collection and new neurological symptoms. Surgeons should be aware of this potential complication when using hemostatic agents in spinal procedures. Careful application, thorough documentation, and vigilant post-operative monitoring are essential. Further research is needed to understand the long-term behavior of fibrin sealants in the intradural space and to develop strategies to prevent migration.