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Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience
R B North1, P N Cutchis, J A Epstein
1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract:
The intraspinal administration of morphine has been employed increasingly in the management of intractable pain of malignant as well as benign origin. We have encountered a previously unreported clinical complication: spinal cord compression by an inflammatory tissue mass surrounding a subarachnoid infusion catheter administering morphine, leading to paraplegia. The patient was referred to our institution after catheter and pump implantation for chronic, intractable pain associated with pre-existing lumbar arachnoid fibrosis, after multiple myelograms and surgeries. The patient may, therefore, have had an underlying propensity to foreign body reactions. We have encountered a similar phenomenon, however, in a canine laboratory model. The pathological features in both our patient and our laboratory preparation, with inflammatory tissue masses around the tip of the catheter but not around proximal subarachnoid segments, suggest an effect related to infusion, as opposed to infection or the presence of the catheter. We review the pathological features in both settings and the pertinent literature.
Insights
Intraspinal morphine infusion can cause spinal cord compression due to inflammatory tissue buildup around the catheter. This rare complication, observed in patients and canine models, leads to paralysis and requires careful monitoring during chronic pain management.
Area of Science:
- Neurology
- Pain Management
- Neurosurgery
Background:
- Intraspinal morphine infusion is increasingly used for intractable pain.
- Pre-existing conditions like lumbar arachnoid fibrosis may increase risk.
- Previous surgeries and myelograms can predispose patients to complications.
Observation:
- A patient developed paraplegia due to spinal cord compression.
- The compression was caused by an inflammatory tissue mass around a subarachnoid morphine infusion catheter.
- A similar phenomenon was observed in a canine laboratory model.
Findings:
- Pathological features indicate inflammatory masses specifically around the catheter tip.
- This suggests an effect related to morphine infusion rather than infection or catheter presence alone.
- The findings were consistent in both the human patient and the canine model.
Implications:
- Highlights a previously unreported complication of intraspinal morphine therapy.
- Suggests the need for vigilance regarding foreign body reactions and catheter-related complications.
- Informs clinical practice and future research on the safety of intrathecal drug delivery systems.