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. 2011 Feb;2(1):57-62.
doi: 10.1055/s-0030-1267087.

Spinal cord compression secondary to intrathecal catheter-induced granuloma: a report of four cases

Paul M Arnold  1 , Viraat Harsh, Seth M Oliphant
Affiliations

Spinal cord compression secondary to intrathecal catheter-induced granuloma: a report of four cases

Paul M Arnold et al. Evid Based Spine Care J. 2011 Feb.

Abstract

Objective: The management of nonmalignant pain by morphine pump implantation has become an effective and increasingly frequent strategy of care. We report a rare complication of intrathecal granuloma formation adjacent to the intrathecal catheter tip resulting in spinal cord compression in four patients undergoing intrathecal treatment for chronic pain.

Methods: Four patients presented with chronic back pain and lower extremity pain and weakness and were treated with morphine pump implantation (Fig 1). Each patient developed a mass at the level of the intrathecal catheter tip resulting in increased back pain and diminished neurological function. Following clinical examination and x-ray workup, the patients underwent surgical resection of the mass and removal of the intrathecal catheter. One patient received conservative saline therapy first, and another patient had granuloma resection first and removal of the intrathecal catheter at a later date. Pathological analysis showed granulation tissue with extensive necrosis and chronic inflammation, with negative culture results. No evidence of neoplasm was found.

Results: Patients showed varying degrees of improvement following removal of the intrathecal mass. Two patients had moderate pain reduction following resection of the granuloma; a third had minimal pain improvement; and a fourth had significant pain improvement but continued lower extremity weakness.

Conclusions: The formation of granulomas caused by intrathecal catheter implantation is a rare but serious complication. Imaging studies including magnetic resonance imaging with contrast and computed tomography with myelogram should be used to follow up a neurological examination consistent with spinal cord compression. Timely surgical intervention may result in marked improvement of symptoms.

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Conflict of interest statement

No funding was received for this work. No investigational device was used. The authors report no conflict of interest.

Figures

Fig 1
Fig 1
Patient sampling and selection.
Fig 2
Fig 2
T1 sagittal magnetic resonance imaging with contrast shows enhancing lesion at T11.
Fig 3
Fig 3
Post-myelogram computed tomography shows granuloma at T11.
See this image and copyright information in PMC

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