Spinal Cord Compression in a Patient with a Pain Pump for Failed Back Syndrome: A Chalk-Like Precipitate Mimicking a Spinal Cord Neoplasm: Case Report

OBJECTIVE AND IMPORTANCE: The use of intrathecal morphine has been effective with few complications for chronic intractable pain of both benign and malignant origins. A rare but serious problem that exists is the formation of an inflammatory mass at the catheter tip of the pain pump. CLINICAL PRESENTATION: We report the case of a 67-year-old female patient with failed back syndrome who presented with sensory complaints and back pain. INTERVENTION: Magnetic resonance imaging revealed impingement on the thoracic cord by a mass. The mass was originally thought to be a spinal cord tumor; however, operation and chemical analysis of the mass showed that it was a bupivacaine precipitate at the tip of the catheter of the pain pump. CONCLUSION: This is the first such case, to our knowledge, of a bupivacaine precipitate mimicking a spinal cord tumor.

[1]  R. Rosenquist,et al.  Intrathecal catheter tip inflammatory mass: a failure of clonidine to protect. , 2005, Anesthesiology.

[2]  T. Kupiec,et al.  Stability of admixture containing morphine sulfate, bupivacaine hydrochloride, and clonidine hydrochloride in an implantable infusion system. , 2004, Journal of pain and symptom management.

[3]  P. Maeder,et al.  Spinal cord lesion after long-term intrathecal clonidine and bupivacaine treatment for the management of intractable pain , 2004, Pain.

[4]  S. Hassenbusch,et al.  Continuous intrathecal infusion of hydromorphone: safety in the sheep model and clinical implications. , 2004, Pain medicine.

[5]  C. Feler,et al.  Catheter Tip Granuloma Associated with Sacral Region Intrathecal Drug Administration , 2003, Neuromodulation : journal of the International Neuromodulation Society.

[6]  C. Sommer,et al.  Chronically Infused Intrathecal Morphine in Dogs , 2003, Anesthesiology.

[7]  V. Hruby,et al.  Effects of Chronic Intrathecal Infusion of a Opioid Agonist in Dogs , 2003 .

[8]  P. Peng,et al.  Spinal Cord Compression From Intrathecal Catheter-Tip Inflammatory Mass: Case Report and a Review of Etiology , 2003, Regional anesthesia and pain medicine.

[9]  Marion R McMillan,et al.  Catheter-Associated Masses in Patients Receiving Intrathecal Analgesic Therapy , 2003, Anesthesia and analgesia.

[10]  S. Hassenbusch,et al.  Inflammatory masses associated with intrathecal drug infusion: a review of preclinical evidence and human data. , 2002, Pain medicine.

[11]  R. Coffey,et al.  Inflammatory Mass Lesions Associated with Intrathecal Drug Infusion Catheters: Report and Observations on 41 Patients , 2001, Neurosurgery.

[12]  T. Deer,et al.  Stability, Compatibility, and Safety of Intrathecal Bupivacaine Administered Chronically via an Implantable Delivery System , 2001, The Clinical journal of pain.

[13]  K. Rice,et al.  Increased tumor necrosis factor-α and nitric oxide production by rat macrophages following in vitro stimulation and intravenous administration of the δ-opioid agonist SNC 80 , 2001 .

[14]  J. Bidlack.  Detection and Function of Opioid Receptors on Cells from the Immune System , 2000, Clinical Diagnostic Laboratory Immunology.

[15]  L. Andrew.  Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report. , 1999 .

[16]  O. Sagher,et al.  Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report. , 1998, Neurosurgery.

[17]  G. Stefano.  Autoimmunovascular regulation: morphine and ancondamide and ancondamide stimulated nitric oxide release , 1998, Journal of Neuroimmunology.

[18]  S. Harland,et al.  Spinal cord compression from precipitation of drug solute around an epidural catheter. , 1998, British Journal of Neurosurgery.

[19]  G. Bejjani,et al.  Intrathecal granuloma after implantation of a morphine pump: case report and review of the literature. , 1997, Surgical neurology.

[20]  J. Blount,et al.  Intrathecal granuloma complicating chronic spinal infusion of morphine. Report of three cases. , 1996, Journal of neurosurgery.

[21]  J. Aldrete,et al.  Paraplegia in a patient with an intrathecal catheter and a spinal cord stimulator. , 1994, Anesthesiology.

[22]  P. J. Hoopes,et al.  Comparative spinal neuropathology of hydromorphone and morphine after 9- and 30-day epidural administration in sheep. , 1994, Anesthesia and analgesia.

[23]  D. Long,et al.  Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience. , 1991, Neurosurgery.

[24]  D. Benhamou,et al.  FACTORS INFLUENCING PRECIPITATION OF pH‐ADJUSTED BUPIVACAINE SOLUTIONS , 1990, Journal of Clinical Pharmacy and Therapeutics.

[25]  W. J. Bean,et al.  Fibrous mass complicating epidural morphine infusion. , 1985, Neurosurgery.

[26]  R. Ojemann,et al.  Cancer pain relieved by long-term epidural morphine with permanent indwelling systems for self-administration. , 1981, Journal of neurosurgery.

[27]  D. Coombs,et al.  CONTINUOUS EPIDURAL ANALGESIA VIA IMPLANTED MORPHINE RESERVOIR , 1981, The Lancet.

[28]  T. Yaksh,et al.  Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin. , 1981, Mayo Clinic proceedings.

[29]  John E. Thomas,et al.  Pain relief by intrathecally applied morphine in man. , 1979, Anesthesiology.