title: Intrapleural migration of a spinal catheter in a patient with arachnoiditis and extensive epidural scarring after tethered cord release: a case report and review of literature.
abstract: OBJECTIVE
  The objective of this study was to report a case of new onset refractory pain from intrapleural migration of a spinal catheter five months after the implantation of an intrathecal drug delivery system (IDDS).
  
  
  METHODS
  A 57-year-old man had intractable pain because of multiple intradural spinal explorations for tethered cord release. His pain was effectively treated with intrathecal morphine via an IDDS. Five months after the implantation, the patient developed return of the original pain more than two weeks after intrapleural migration of the intrathecal catheter.
  
  
  RESULTS
  The migration was documented by computed tomography, and repositioning of the catheter rendered the patient comfortable. The gradual onset of pain may have been due to decreasing delivery of drug to the cerebrospinal fluid as the catheter tip migrated further away from the dura. To our knowledge, this complication has not been reported in the literature.
  
  
  CONCLUSIONS
  Physicians and nursing staff that place and manage an IDDS should be aware of this complication.
authors.affiliation: Department of Anesthesia and Critical Care, Pain Management, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Anitescu
authors.forename: Arnaldo Neves
authors.initials: AN
authors.lastname: DaSilva
authors.forename: David M
authors.initials: DM
authors.lastname: Frim
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage; D001100:Arachnoiditis / Q000150:complications / Q000473:pathology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications / Q000473:pathology; D004388:Dura Mater / Q000473:pathology; D004868:Equipment Failure; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009436:Neural Tube Defects / Q000601:surgery; D010146:Pain / Q000188:drug therapy / Q000209:etiology*; D010994:Pleura / Q000473:pathology*; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine