alexa Epidural Granuloma by Dislocated Catheter Tip Associate
ISSN: 2327-5146

General Medicine: Open Access
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Case Report

Epidural Granuloma by Dislocated Catheter Tip Associated with Spinal Cord Compression in High-Dose Intrathecal Morphine Therapy

Koeck K1*, Grossauer S1, Trummer M1 and Kleinert R2
1Department of Neurosurgery, Medical University Graz, Austria
2Department of Pathology, Medical University Graz, Austria
Corresponding Author : Koeck K
Department of Neurosurgery
Medical University Graz, Austria
E-mail: [email protected]
Received August 20, 2013; Accepted September 10, 2013; Published September 20, 2013
Citation: Koeck K, Grossauer S, Trummer M, Kleinert R (2013) Epidural Granuloma by Dislocated Catheter Tip Associated with Spinal Cord Compression in High- Dose Intrathecal Morphine Therapy. Gen Med (Los Angel) 1:117. doi: 10.4172/2327-5146.1000117
Copyright: © 2013 Koeck K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Intrathecal drug delivery systems are an option for selected patients with chronic pain. Complications such as intrathecal catheter-tip inflammatory masses are already reported in literature. In the present case report we describe a patient suffering from neuropathic pain located on the anterior aspects of both thighs following failed back surgery. Two years after implantation of an intrathecal morphine pump system the patient experienced symptoms of a spinal cord compression with increasing radicular pain, especially after application of morphine bolus. Within this time frame the average daily intrathecal morphine hydrochloride dose was 3.2 mg per day and the total neuraxial morphine hydrochloride dose was 2460 mg. Magnetic resonance imaging revealed spinal cord compression from an epidural mass measuring 13×11×10 millimeters, originating from an epidural dislocation of the intrathecal catheter. After surgical removal of the mass, histological examination confirmed a disseminated formation of a granuloma. What makes this case so special, is the fact that the granuloma is not located intrathecally, but in the epidural space (epidural granuloma). The formation of a purely epidural granuloma due to a dislocated catheter tip has - according to our research - not been reported about up to the present.

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