Intrathecal granuloma after implantation of a morphine pump: case report and review of the literature

Abstract

Background: Intrathecal morphine pumps are being increasingly used in patients with benign pain who have a longer life expectancy than cancer patients. Newer complications may be encountered.

Clinical presentation: We report a complication that occurred in a 48-year-old woman who presented with intractable lower back pain 18 months after morphine pump implantation. Magnetic resonance imaging of the lumbosacral spine revealed an intrathecal mass around the catheter. At surgery, an inflammatory mass was found without any evidence of neoplasia or infection. This is a very unusual complication of intrathecal morphine pumps. (Related animal and human studies are reviewed in this article.)

Conclusion: Long-term use of implantable pumps may carry increased risks that are not observed during the short-term experience of cancer patients. Reimaging is important in evaluating patients who have developed uncontrollable pain and new neurologic findings.