Spinal cord compression from intrathecal catheter-tip inflammatory mass: case report and a review of etiology.
OBJECTIVE
The majority of intrathecal pumps are implanted by anesthesiologists. Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature. The present case report describes a patient with spinal cord compression as a result of an inflammatory mass and reviews the current literature as to the etiology of inflammatory mass formation.


METHODS
A 47-year-old man with intractable neck and arm pain received an intrathecal pump implantation in 2001, at a stable dose of morphine 8 mg and clonidine 40 microg/d. After an injury in late 2001, his dose requirement for intrathecal morphine steadily increased. In May 2002, hydromorphone was substituted for morphine. The concentrations of hydromorphone and clonidine were 12.5 mg/mL and 150 microg/mL, respectively, infusing at 0.3 mL/d. In October 2003, he developed progressive T9 paraparesis. A computed tomography scan with myelogram showed complete blockage of contrast flow at T8-9. Surgical exploration found an intradural-extramedullary mass compressing the spinal cord anteriorly and to the left. Four weeks after surgical removal of the mass, the patient's neurologic function had improved minimally. All the microbiological analyses were negative. Review of the current literature suggests that the development of an inflammatory mass is related to the delivery of the high dose opioids in the intrathecal space.


CONCLUSIONS
Delivery of high-dose intrathecal opioids can result in the formation of an inflammatory mass, leading to poor pain control and neurologic complications. Anesthesiologists should be vigilant as to these complications when managing patients receiving intrathecal pump therapy.
Peng
Philip
P
Department of Anesthesiology,Toronto Western Hospital EC 2-046, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8. Philip.peng@uh.on.ca
Massicotte
Eric M
EM
D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery