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LETTER TO THE EDITOR

Intrathecal Therapy-Associated Masses

Department of Anesthesiology and Pain Management; University of Arkansas Medical Sciences; Little Rock, AR; metagentian{at}uams.edu

To the Editor:

One serious but rare complication of chronic intrathecal opioids is the formation of inflammatory masses in the intrathecal space (1,2). Although more commonly described for morphine, intrathecal masses have also been reported for hydromorphone (3).

A 48-yr-old male with a history of ankylosing spondylitis, early stage osteoporosis, vertebral fractures, and severe back pain treated with chronic hydromorphone and bupivacaine intrathecal infusions presented with progressive weakness of the lower extremities. An intrathecal pump had been placed approximately 8 yr earlier. Previous trials of intrathecal morphine had been discontinued because of urinary retention. He was receiving 41 mg/day hydromorphone and bupivacaine mixture at the time of presentation.

A myelogram demonstrated an extradural defect on the left side at T9-10 and a small lucent area at T10-11, interpreted as a meningioma by the radiologist. The patient was scheduled for tumor resection. During surgery, an intradural mass was found, encasing the catheter. The mass and catheter tip were resected. Pathological analysis indicated the mass had no tumor cells and the cultures were negative.

Patients with intrathecal catheter-associated masses have variable clinical presentations. Presentation usually occurs with symptoms of spinal cord compression. This is typically not an issue in terminal cancer patients because of the short duration of exposure. However, the risk of an inflammatory mass and possible neurological injury must be weighed against the potential benefits of long-term intrathecal infusions for chronic pain. Future research may help determine of opioid selection or dose can reduce the incidence of this uncommon complication.

REFERENCES

1. Yaksh TL, Hassenbusch S, Burchiel K, et al. Inflammatory masses associated with intrathecal drug infusion: a review of preclinical and human data. Pain Med 2002;3:300–12.[Web of Science][Medline]
2. McMillan MR, Doud T, Nugent W. Catheter associated masses in patients receiving intrathecal analgesic therapy. Anesth Analg 2003;96:186–90.[Abstract/Free Full Text]
3. Coffey RJ, Burchiel K. Inflammatory mass lesions associated with intrathecal drug infusion catheters: report and observations on 41 patients. Neurosurgery 2002;50:78–87.[Web of Science][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Meta, G. Articles by Firnhaber, J. Search for Related Content PubMed PubMed Citation Articles by Meta, G. Articles by Firnhaber, J.