Traumatic syrinx after implantation of an intrathecal catheter

This case report describes the diagnosis and subsequent management of a very unusual complication of intrathecal pump insertion, namely that of traumatic syrinx secondary to the presence of an intrathecal catheter within the substance of the spinal canal.

A woman with a 10-year history of chronic pain after a fall was scheduled to have an intrathecal pump inserted to deliver morphine as a continuous infusion. The intrathecal space was entered at L(1)/L(2). Under fluoroscopic imaging, the catheter was threaded to the T6 level. The catheter was then secured and tunneled subcutaneously and implanted in the anterior abdominal wall. After implantation, the patient complained of difficulty in moving her left leg with loss of spinothalamic sensation on her left side from T(6) to L(5). Magnetic resonance imaging (MRI) showed a traumatic syrinx secondary to the presence of an intrathecal catheter within the substance of the canal. The catheter was removed, and serial MRI revealed the syrinx had not increased in size. The patient underwent reinsertion of an intrathecal catheter for control of her pain. Her postoperative course thereafter was uneventful.

Insertion of an intrathecal catheter may be associated with spinal cord trauma in patients receiving general anesthesia. Serial neurologic examinations and MRI are helpful in guiding treatment.