Zeitschrift für klinische Fallberichte

Blame it on the Pump

Abstract

Kirk J. Levins

Intrathecal drug delivery a method of directly administering opioid and spasmolytic medication to the site of action, the spinal cord. Efficacy and safety of this delivery system is well documented in cancer pain, spasticity as well as non-malignant pain. However, there are a number of recognised potential complications with this therapy. One of the most serious of which is the formation of a granuloma occurring at the intrathecal catheter tip, which appears to be related to the concentration and drug type being delivered. Evidence has indicated that delivery of high dose morphine can lead to the formation of these granulomas. Occurring in less than 3% of all patients with an intrathecal catheter, granulomas can present as an inflammatory mass on imaging with some resulting in compression of the spinal cord. Patients may present with a host of neurological symptoms dependent on the location of cord compression caused by the granuloma, including neurological deficits, myelopathy and radiculopathy.