Paraplegia in a Patient with an Intrathecal Catheter and a Spinal Cord Stimulator

Aldrete, J. Antonio; Vascello, Luis; Ghaly, Ramsis F.; Tomlin, Dianne

doi:10.1097/00000542-199412000-00002

Cited by 29 publications

(27 citation statements)

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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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“…An intrathecal tip granuloma is a mass of fibrous tissue that is formed around the intrathecally placed catheter tip, which, if not excised in due time, can cause more or less severe and permanent neurologic damage, and may even lead to paraplegia. Its etiology is unknown, but it seems to be related to the long‐term intrathecal infusion of high doses of spinal analgesics (11–18). The aim of our study (observational, nonrandomized, and noncontrolled) was to retrospectively examine our results obtained as regards to analgesia, drug dose, tolerance, complications if any, and short and long‐term side effects in 39 patients with nonmalignant chronic pain of neuropathic and nociceptive origin.…”

Section: Introductionmentioning

confidence: 99%

Spinal Morphine in Nonmalignant Chronic Pain: A Retrospective Study in 39 Patients

Gay

2002

Neuromodulation: Technology at the Neural Interface

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It was the purpose of this study to retrospectively test the safety and efficacy of the use of intraspinal analgesics in a diverse population of patients with chronic nonmalignant pain. This study was conducted in 39 patients, refractory to conventional therapies for intrathecal therapy. Twenty-two patients had neuropathic pain and 17 had nociceptive pain. The mean follow-up of this patient population was 2.2 years with a range of 36 months to 6.5 years. Analgesia with intraspinal morphine, initial and final dose of intraspinal agents used, stability of morphine dose over time, and side effects and complications with or without bupivacaine and/or clonidine was assessed after 6 months of treatment, and at the end of study. After 6 months, three patients discontinued the study for differing reasons, 28 patients (77.8%) reported excellent results, and five patients (14%) reported good results. One patient reported no pain relief with intraspinal morphine and bupivacaine and five patients reported insufficient or no pain relief. At final assessment, 20 patients (55.6%) reported excellent results with no differences based on pain type or pain syndrome and eight patients (22.2%) reported good analgesia. Morphine doses remained stable throughout treatment, with an average dose of 2 mg per patient. Ninety-one percent of patients were satisfied with the method used and considered it superior to all previous therapeutic techniques tried, improving their quality of life. As for complications, one patient developed a clostridial infection during the immediate postoperative period which required pump removal and one patient developed severe urinary retention requiring system removal. There were three catheter obstructions (two in the same patient) and one catheter disconnection. Other patient-reported side effects were not considered significant by the authors to be mentioned here. After more than 6 years of experience with spinal infusion of morphine, either alone or admixed with other spinal analgesics, in patients with pain of nonmalignant origin, we consider the technique to be helpful in selected patients not responding to oral treatment or when untoward side effects exist with oral treatment. The advantages, as regards to analgesic efficacy and quality of life, clearly outweigh the drawbacks of the long-term use of spinal morphine.

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“…We feel that close follow‐up of patients with intraspinal drug administration catheters is imperative to attempt avoidance of complications, irrespective of the drug or drugs used for infusion. Aldrete has suggested the use of pump refilling and programming clinic visits as a point to examine the patient's neurologic exam (5). Not only is a complete motor examination essential, a sensory change may allow for recognition of early catheter tip granulomas.…”

Section: Discussionmentioning

confidence: 99%

Catheter Tip Granuloma Associated with Sacral Region Intrathecal Drug Administration

Fernandez¹,

Madison‐Michael²,

Feler³

2003

Neuromodulation: Technology at the Neural Interface

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Spinal cord compression from catheter tip granulomatous masses following intrathecal drug administration may produce devastating permanent neurologic deficits. Some authors have advocated intrathecal catheter placement below the conus medullaris to avoid the possibility of spinal cord involvement. Multiple cases of catheter tip granulomas in the thoracolumbar region have been reported. We present a unique case of a sacral region catheter tip inflammatory mass producing permanent neurologic deficits. A 71-year-old white male with a diagnosis of failed back surgery syndrome was referred to the senior author for evaluation. After more extensive conservative therapy, including spinal cord stimulation, failed to yield adequate pain relief, he was offered implantation of an intrathecal pump for opioid administration. Excellent pain relief was achieved in the postoperative period; however, three years after implantation, he presented with progressive saddle anesthesia and bowel/bladder incontinence. Magnetic resonance imaging demonstrated a space occupying lesion associated with the catheter tip. The patient underwent emergent second level complete sacral laminectomy with partial resection of an intradural extra-axial mass and removal of intrathecal catheter. At discharge, the patient had no restoration of neurologic function. Histologic examination of the mass confirmed a sterile inflammatory mass. It has been suggested that intrathecal catheters be placed below the conus medullaris to avoid the possibility of spinal cord involvement. We present an unusual case documenting devastating permanent neurologic deficits from a catheter tip granuloma in the sacral region.

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Paraplegia in a Patient with an Intrathecal Catheter and a Spinal Cord Stimulator

Cited by 29 publications

References 0 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

Spinal Morphine in Nonmalignant Chronic Pain: A Retrospective Study in 39 Patients

Catheter Tip Granuloma Associated with Sacral Region Intrathecal Drug Administration

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