title: The complications of scar formation associated with intrathecal pump placement.
abstract: A 40-year-old man had an intrathecal morphine-baclofen pump inserted for the treatment of severe dystonia affecting all limbs and severe low back pain. The etiology of his dystonic symptoms, despite thorough investigations, was uncertain. At age 45, the patient fell resulting in a cervical spinal cord injury. He underwent C2 through C5 instrumentation and fusion for cervical spine stabilization. Subsequently, an intrathecal morphine-baclofen pump was implanted to control pain and decrease spasticity. The patient ultimately died at age 48 from complications of pneumonia, and an autopsy was performed. Gross pathologic examination revealed that the intrathecal catheter entered the posterior aspect of the lumbar thecal sac, but coursed superiorly in the anterior intradural space. The catheter tip exited the thecal sac in the upper thoracic spine and became embedded in a fibrotic scar. Displacement of the catheter tip of the intrathecal morphine-baclofen pump and subsequent formation of scar tissue resulted in decreased drug delivery, contributing to diminished pain control and functional status. Catheter displacement and epidural scar formation must be considered as a potential cause of ineffective pain control and decreased functional status in patients with intrathecal morphine-baclofen pumps.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Marina G
authors.initials: MG
authors.lastname: Protopapas
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bundock
authors.forename: Susan
authors.initials: S
authors.lastname: Westmoreland
authors.forename: Christopher
authors.initials: C
authors.lastname: Nero
authors.forename: W Andrew
authors.initials: WA
authors.lastname: Graham
authors.forename: Shanker
authors.initials: S
authors.lastname: Nesathurai
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001418:Baclofen / Q000008:administration & dosage; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications*; D004421:Dystonia / Q000188:drug therapy; D019544:Equipment Failure Analysis; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000295:instrumentation; D017116:Low Back Pain / Q000188:drug therapy; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D009125:Muscle Relaxants, Central / Q000008:administration & dosage
chemical_list: D000701:Analgesics, Opioid; D009125:Muscle Relaxants, Central; D009020:Morphine; D001418:Baclofen