Gelfoam as a barrier to prevent polymethylmethacrylate-induced thermal injury of the spinal cord: in vitro and in vivo studies in pigs

Abstract

Gelatin sponge (Gelfoam; Upjohn, Kalamazoo, MI, U.S.A.) is commonly used as an interpositional barrier to shield the spinal cord from thermal injury during vertebral reconstruction with polymethylmethacrylate bone cement. The aim of this study was to record epidural and intradural temperatures during polymethylmethacrylate reconstruction of vertebral corpectomy defects. Three surgical techniques (subtotal corpectomy, total corpectomy with insertion of a Gelfoam barrier, and total corpectomy with no barrier) were compared in vivo and in vitro in a porcine model. As expected, total corpectomy defects cemented without a Gelfoam barrier produced the highest epidural temperatures in vivo (52.8 degrees C) and in vitro (58 +/- 2 degrees C). The Gelfoam barrier provided some protection against heat transfer, but peak temperatures and absolute temperature increases were significantly higher than in defects with an intact posterior cortex (p < 0.05). These results indicate that an intact posterior cortex provides the best protection against heat transfer, whereas the use of a Gelfoam barrier appears to provide only partial protection against thermal injury.