title: Development of scoliosis following intrathecally placed opioid pump for chronic low back pain.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report a case and review the literature on development of scoliosis following intrathecally placed opioid pump for chronic low back pain.
  
  
  BACKGROUND
  Intrathecal opioid administration is a technique currently indicated for the management of chronic pain syndromes. Despite evidence of scoliosis occurring after baclofen pump insertion, there has been no evidence that development of scoliosis occurs following implantation of an intrathecally placed opioid pump for treatment of lower back pain (LBP).
  
  
  METHODS
  A retrospective review of patients with adult onset scoliosis was performed at our institution. One patient was identified as showing significant scoliotic progression following implantation of an intrathecally placed opioid pump. Radiographs were analyzed to evaluate the magnitude and configuration of her kyphoscoliosis following pump insertion.
  
  
  RESULTS
  A 50-year-old woman with intractable LBP underwent placement of a spinal cord stimulator (SCS) followed shortly by removal of the SCS and placement of an intrathecal opioid pump. Five years later, she presented with severe kyphoscoliosis involving a left thoracolumbar curve of 84 degrees and sagittal balance of 158 mm. Because of intractable pain and progressive deformity, she underwent multilevel osteotomies, instrumented fusion, and replacement of her Dilaudid pump. Postoperative radiographs demonstrated a residual 23 degrees thoracolumbar curve with restoration of her sagittal alignment. No major morbidity/mortality occurred with treatment.
  
  
  CONCLUSIONS
  Although there may not be a direct correlation between implantation of an intrathecal opioid pump with subsequent development of adult onset scoliosis, deformity must be considered a potential sequela in patients treated with such neuromodulation.
authors.affiliation: Department of Neurological Surgery, Johns Hopkins University, Baltimore, MD, USA. dsciubb1@jhmi.edu
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Li-Mei
authors.initials: LM
authors.lastname: Lin
authors.forename: James E
authors.initials: JE
authors.lastname: Conway
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Khaled
authors.initials: K
authors.lastname: Kebaish
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000009:adverse effects; D017116:Low Back Pain / Q000188:drug therapy*; D008875:Middle Aged; D010148:Intractable Pain / Q000188:drug therapy; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid