A case of spinal cord compression syndrome by a fibrotic mass presenting in a patient with an intrathecal pain management pump system.
A 45-year-old woman presented with increasing low back pain, progressive anesthesia in her lower extremities and difficulty ambulating. She had a history of chronic low back pain problems for which, 26 months earlier, she had an intrathecal infusion pump permanently placed for pain and spasm control. Urgent magnetic resonance imaging (MRI) of the lumbar spine revealed a mass at the site of the tip of the intrathecal catheter with high grade spinal cord compression at the level of L-1. At surgical laminectomy the compressing lesion was found to be a reactive tissue fibroma. As more patients receive these devices the physician should consider cord compression syndrome in patients presenting with symptoms of increasing low back pain, anesthesia and progressive proprioceptive loss.
Langsam
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Department of Emergency Medicine, Christiana Care Health Systems, Christiana Hospital, Ogletown-Stanton Road, Newark, USA. alangsam@dfes.com
D000775:Anesthesia, Spinal; D002908:Chronic Disease; D005260:Female; D005350:Fibroma / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal; D007796:Laminectomy; D017116:Low Back Pain / Q000188:drug therapy*; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery