title: Thoracic Nerve Root Entrapment by Intrathecal Catheter Coiling: Case Report and Review of the Literature.
abstract: BACKGROUND
  Intrathecal catheter placement has long-term therapeutic benefits in the management of chronic, intractable pain. Despite the diverse clinical applicability and rising prevalence of implantable drug delivery systems in pain medicine, the spectrum of complications associated with intrathecal catheterization remains largely understudied and underreported in the literature.
  
  
  OBJECTIVE
  To report a case of thoracic nerve root entrapment resulting from intrathecal catheter migration.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Inpatient hospital service.
  A 60-year-old man status post implanted intrathecal (IT) catheter for intractable low back pain secondary to failed back surgery syndrome returned to the operating room for removal of IT pump trial catheter after experiencing relapse of preoperative pain and pump occlusion. Initial attempt at ambulatory removal of the catheter was aborted after the patient reported acute onset of lower extremity radiculopathic pain during the extraction. Noncontrast computed tomography (CT) subsequently revealed that the catheter had ascended and coiled around the T10 nerve root. The patient was taken back to the operating room for removal of the catheter under fluoroscopic guidance, with possible laminectomy for direct visualization. Removal was ultimately achieved with slow continuous tension, with complete resolution of the patient's new radicular symptoms.
  
  
  CONCLUSIONS
  This report describes a single case report.
  
  
  CONCLUSIONS
  This case demonstrates that any existing loops in the intrathecal catheter during initial implantation should be immediately re-addressed, as they can precipitate nerve root entrapment and irritation. Reduction of the loop or extrication of the catheter should be attempted under continuous fluoroscopic guidance to prevent further neurosurgical morbidity.
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, NC.
authors.forename: Jing L
authors.initials: JL
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, NC.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Loriaux
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, NC.
authors.forename: Caroline
authors.initials: C
authors.lastname: Tybout
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, NC.
authors.forename: Merritt D
authors.initials: MD
authors.lastname: Kinon
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, NC.
authors.forename: Shervin
authors.initials: S
authors.lastname: Rahimpour
authors.affiliation: Pain Medicine Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Runyon
authors.affiliation: Pain Medicine Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hopkins
authors.affiliation: Pain Medicine Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Boortz-Marx
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, NC.
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
mesh_terms: D000328:Adult; D000700:Analgesics; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D055111:Failed Back Surgery Syndrome / Q000000981:diagnostic imaging; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D015918:Infusion Pumps, Implantable; D008297:Male; D013126:Spinal Nerve Roots / Q000000981:diagnostic imaging* / Q000601:surgery; D013900:Thoracic Nerves / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D000700:Analgesics