Presented at the 2013 AAPM Annual Meeting « Back

Patients with A History of Spine Surgery or Spinal Injury May Have A Higher Chance of Intrathecal Catheter Granuloma Formation

Dmitri Souzdalnitski, MD PhD, dmitrisouz@gmail.com¹, Alfred Beshai, MD², Zachary M. Arnold³, Daria Suzdalnitskaya⁴, Samer Narouze, MD PhD⁵, (1) South Pointe Hospital Pain Management Center – Western Reserve Hospital, Cleveland, Ohio, (2) Louis Stokes VAMC, Westlake, Ohio, (3) Cleveland Clinic, Cleveland, Ohio, (4) South Pointe Hospital, Warrensville Heights, Ohio, (5) Summa Western Reserve Hospital, Cuyahoga Falls, Ohio

Background: Intrathecal drug delivery is an effective method to treat intractable pain. However, intrathecal catheter tip granuloma (ICTG) is a devastating complication of intrathecal drug delivery systems. It typically occurs in the thoracic region; particularly, in patients receiving high doses or high concentrations of intrathecal drug infusions. Materials and Methods: The PUBMED/MEDLINE and Cochrane databases were also systematically searched for all reports on ICTG published in any language. The key words included “intrathecal,” “granuloma,” and “spine surgery,” and all related publications between the earliest available date (the first granuloma-related chronic complication of intrathecal infusion reported in PUBMED/MEDLINE in 1996) and June (week 1) of 2012 were searched. Results: Cerebrospinal fluid flow dynamics within the spinal canal along with the physical, chemical, and immunological properties of intrathecal medications have been suggested to be responsible for the growth of inflammatory mass lesions at the tips of intrathecal drug delivery catheters. Our literature review supports the possible role of certain factors, specifically previous spine surgery or spinal injury, in granuloma formation. The rate of development of ICTG appears to be higher in patients who have had previous spine surgery or spinal injury (68%) than in a general cohort of patients (48%), with an intrathecal pump. Conclusion: Patients with a history of spine surgery or injury may be at increased risk of ICTG when receiving chronic intrathecal analgesia.

Funding: None

Figures: