Intrathecal granuloma complicating chronic spinal infusion of morphine

Blount, Jeffrey P.; Remley, Kent B.; Yue, Samuel K.; Erickson, Donald L.

doi:10.3171/jns.1996.84.2.0272

Cited by 75 publications

(75 citation statements)

References 31 publications

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“…14,21,23,24,31,35,36,79 There were case reports of traumatic syrinx owing to penetration of the spinal cord by the intrathecal 29 There was a report of withdrawal symptoms due to catheter disconnection from the pump. 28…”

Section: Complicationsmentioning

confidence: 99%

Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications

Turner¹,

Sears

Loeser

2007

The Clinical Journal of Pain

140

120

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The studies reviewed found improvement in pain and functioning on average among patients with chronic noncancer pain who received permanent IDDS. However, their methodologic limitations preclude conclusions concerning the effectiveness of this technology long-term and as compared with other treatments. Drug side effects and hardware complications were common. Suggestions are made for methodologic improvements in future studies.

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Section: Complicationsmentioning

confidence: 99%

Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications

Turner¹,

Sears

Loeser

2007

The Clinical Journal of Pain

140

120

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“…Ist sie, wie in der Leitlinie formuliert, eine Methode, die "in vielen Fäl-len Vorzüge gegenüber der systemischen [3,8,9,25].…”

Section: Unerwünschte Ereignisse Und Komplikationen Der Intrathekalenunclassified

Neurologische Komplikationen und Wirkverlust unter intrathekaler Schmerztherapie

Kindler

Maier

Kagel

et al. 2005

Schmerz

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In a new guideline issued by the German Association for the Study of Pain, intrathecal opioid therapy is described as proven to be effective with relatively few side effects. We reviewed this statement by analysis of the available literature and critical evaluation of the clinical course in a few of our own patients (n=3). In these cases (as well as in a further eight patients), explantation and a switch to oral opioids led to distinctly better alleviation of pain and abatement of the unwanted effects. The problems we discuss do not appear to be rare instances, but by all means complications that are frequently described. The long-term efficacy of intrathecal opioids has not been adequately verified; moreover, their potency is not high. The frequency of undesired events is comparable to that of oral opioid medication, but serious neurological complications are possible. To avoid dose escalations and to recognize neurological complications in time, diligent monitoring by the surgeon or an experienced pain center is essential.

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“…The incidence and prevalence of these complications are inconsistent in literature and range from approximately one intrathecal mass per 1000 patients [12] to three intrathecal masses out of a group of 60 patients [13]. The incidence of inflammatory mass lesions after 1 year of therapy has been estimated to be 0.04% but increases to 1.15% after 6 years [11].…”

Section: Introductionmentioning

confidence: 99%

Epidural Granuloma by Dislocated Catheter Tip Associated with Spinal Cord Compression in High-Dose Intrathecal Morphine Therapy

R¹

2013

General Med

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Intrathecal drug delivery systems are an option for selected patients with chronic pain. Complications such as intrathecal catheter-tip inflammatory masses are already reported in literature. In the present case report we describe a patient suffering from neuropathic pain located on the anterior aspects of both thighs following failed back surgery. Two years after implantation of an intrathecal morphine pump system the patient experienced symptoms of a spinal cord compression with increasing radicular pain, especially after application of morphine bolus. Within this time frame the average daily intrathecal morphine hydrochloride dose was 3.2 mg per day and the total neuraxial morphine hydrochloride dose was 2460 mg. Magnetic resonance imaging revealed spinal cord compression from an epidural mass measuring 13×11×10 millimeters, originating from an epidural dislocation of the intrathecal catheter. After surgical removal of the mass, histological examination confirmed a disseminated formation of a granuloma. What makes this case so special, is the fact that the granuloma is not located intrathecally, but in the epidural space (epidural granuloma). The formation of a purely epidural granuloma due to a dislocated catheter tip has -according to our research -not been reported about up to the present.

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Intrathecal granuloma complicating chronic spinal infusion of morphine

Cited by 75 publications

References 31 publications

Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications

Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications

Neurologische Komplikationen und Wirkverlust unter intrathekaler Schmerztherapie

Epidural Granuloma by Dislocated Catheter Tip Associated with Spinal Cord Compression in High-Dose Intrathecal Morphine Therapy

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