Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report

Neurosurgery. 1998 May;42(5):1176-80; discussion 1180-1. doi: 10.1097/00006123-199805000-00142.

Abstract

Objective and importance: The use of chronic intrathecal morphine for the treatment of intractable, nonmalignant pain is becoming more prevalent. A rare but devastating complication of this therapy is the development of spinal cord compression secondary to the formation of intrathecal granulomas.

Clinical presentation: We report three cases of intrathecal granuloma formation in the thoracic subarachnoid space, associated with intrathecal morphine pumps. These three patients were receiving high doses of morphine to control their pain (25 mg/d, 28 mg/d, and 45 mg/d, respectively) when they presented with signs and symptoms of thoracic spinal cord compression. Myelography and postmyelographic computed tomography of the spine revealed masses causing spinal cord compression.

Intervention: Two patients underwent thoracic laminectomies for resection of these masses, and the other patient had the intrathecal catheter removed. A pathological examination revealed sterile granulomas in the resected masses.

Conclusion: Intrathecal granulomas are likely to occur with increasing frequency as the use of chronic intrathecal morphine delivery increases in patients with nonmalignant pain. The cause of intrathecal granulomas is unknown, although it is likely that morphine plays a major role in their formation. We think that those patients receiving high doses of morphine are at greater risk for developing this complication.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / therapeutic use
  • Anus Neoplasms / complications
  • Carcinoma / complications
  • Female
  • Granuloma / chemically induced
  • Granuloma / complications*
  • Granuloma / surgery
  • Granuloma, Foreign-Body / etiology
  • Humans
  • Hydromorphone / administration & dosage
  • Hydromorphone / therapeutic use
  • Infusion Pumps, Implantable / adverse effects*
  • Injections, Spinal / adverse effects*
  • Laminectomy
  • Low Back Pain / drug therapy
  • Magnetic Resonance Imaging
  • Meningitis / chemically induced
  • Meningitis / complications*
  • Meningitis / surgery
  • Middle Aged
  • Morphine / administration & dosage
  • Morphine / adverse effects*
  • Morphine / therapeutic use
  • Neurofibromatoses / complications
  • Pain, Intractable / drug therapy
  • Paresis / etiology
  • Recurrence
  • Sensation Disorders / etiology
  • Spinal Cord Compression / etiology*

Substances

  • Analgesics, Opioid
  • Morphine
  • Hydromorphone