Intrathecal granuloma complicating chronic spinal infusion of morphine

Report of three cases

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  • 1 Departments of Neurosurgery and Radiology, and Division of Neuroradiology, University of Minnesota School of Medicine, St. Paul, Minnesota; and the Minnesota Pain Center, St. Paul, Minnesota
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✓ Intrathecal morphine delivered by implanted pumps has been used in the treatment of pain caused by terminal cancer. Some authors supports its use in benign pain as well. The authors present three cases in which chronic infiltration of intraspinal narcotic medication was complicated by the formation of a granulomatous mass that became large enough to exert mass effect and induce neurological dysfunction.

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JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Abouleish E, , Barmada MA, & Nemoto EM, et al: Acute and chronic effects of intrathecal morphine in monkeys. Br J Anaesth 53:10271032, 1981 Abouleish E, Barmada MA, Nemoto EM, et al: Acute and chronic effects of intrathecal morphine in monkeys. Br J Anaesth 53:1027–1032, 1981

    • Search Google Scholar
    • Export Citation
  • 2.

    Auld AW, , Maki-Jokela A, & Murdoch DM: Intraspinal narcotic analgesia in the treatment of chronic pain. Spine 10:777781, 1985 Auld AW, Maki-Jokela A, Murdoch DM: Intraspinal narcotic analgesia in the treatment of chronic pain. Spine 10:777–781, 1985

    • Search Google Scholar
    • Export Citation
  • 3.

    Auld AW, , Murdoch DM, & O'Laughlin KA: Intraspinal narcotic analgesia. Pain management in the failed laminectomy syndrome. Spine 12:953954, 1987 Auld AW, Murdoch DM, O'Laughlin KA: Intraspinal narcotic analgesia. Pain management in the failed laminectomy syndrome. Spine 12:953–954, 1987

    • Search Google Scholar
    • Export Citation
  • 4.

    Bahar M, , Rosen M, & Vickers MD: Chronic cannulation of the intradural or extradural space in the rat. Br J Anaesth 56:405408, 1984 Bahar M, Rosen M, Vickers MD: Chronic cannulation of the intradural or extradural space in the rat. Br J Anaesth 56:405–408, 1984

    • Search Google Scholar
    • Export Citation
  • 5.

    Brook I: Role of anaerobic bacteria in aortofemoral graft infection. Surgery 104:843848, 1988 Brook I: Role of anaerobic bacteria in aortofemoral graft infection. Surgery 104:843–848, 1988

    • Search Google Scholar
    • Export Citation
  • 6.

    Brook I, & Frazier E: Anaerobic osteomyelitis and arthritis in a military hospital: a 10 year experience. Am J Med 94:2128, 1993 Brook I, Frazier E: Anaerobic osteomyelitis and arthritis in a military hospital: a 10 year experience. Am J Med 94:21–28, 1993

    • Search Google Scholar
    • Export Citation
  • 7.

    Chien AM, , Raber IM, & Fisher DH, et al: Propionibacterium acne endophthalmitis after intracapsular cataract extraction. Ophthalmology 99:487490, 1992 Chien AM, Raber IM, Fisher DH, et al: Propionibacterium acne endophthalmitis after intracapsular cataract extraction. Ophthalmology 99:487–490, 1992

    • Search Google Scholar
    • Export Citation
  • 8.

    Coombs DW, , Colburn RW, & Allen CD, et al: Toxicity of chronic spinal analgesia in a canine model: neuropathologic observations with dezocine lactate. Reg Anesth 15:94102, 1990 Coombs DW, Colburn RW, Allen CD, et al: Toxicity of chronic spinal analgesia in a canine model: neuropathologic observations with dezocine lactate. Reg Anesth 15:94–102, 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Coombs DW, , Fratkin JD, & Meier FA, et al: Neuropathologic lesions and CSF morphine concentrations during chronic continuous intraspinal morphine infusion. A clinical and post-mortem study. Pain 22:337351, 1985 Coombs DW, Fratkin JD, Meier FA, et al: Neuropathologic lesions and CSF morphine concentrations during chronic continuous intraspinal morphine infusion. A clinical and post-mortem study. Pain 22:337–351, 1985

    • Search Google Scholar
    • Export Citation
  • 10.

    Coombs DW, , Maurer LH, & Saunders RL, et al: Outcomes and complications of continuous intraspinal narcotic analgesia for cancer pain control. J Clin Oncol 2:14141420, 1984 Coombs DW, Maurer LH, Saunders RL, et al: Outcomes and complications of continuous intraspinal narcotic analgesia for cancer pain control. J Clin Oncol 2:1414–1420, 1984

    • Search Google Scholar
    • Export Citation
  • 11.

    Coombs DW, , Saunders RL, & Gaylor M, et al: Epidural narcotic infusion reservoir: implantation technique and efficacy. Anesthesiology 56:469473, 1982 Coombs DW, Saunders RL, Gaylor M, et al: Epidural narcotic infusion reservoir: implantation technique and efficacy. Anesthesiology 56:469–473, 1982

    • Search Google Scholar
    • Export Citation
  • 12.

    Coombs DW, , Saunders RL, & Gaylor MS, et al: Relief of continuous chronic pain by intraspinal narcotics infusion via an implanted reservoir. JAMA 250:23362339, 1983 Coombs DW, Saunders RL, Gaylor MS, et al: Relief of continuous chronic pain by intraspinal narcotics infusion via an implanted reservoir. JAMA 250:2336–2339, 1983

    • Search Google Scholar
    • Export Citation
  • 13.

    Erickson DL, , Blacklock JB, & Michaelson M: Control of spasticity by implantable continuous flow morphine pump. Neurosurgery 16:215217, 1985 Erickson DL, Blacklock JB, Michaelson M: Control of spasticity by implantable continuous flow morphine pump. Neurosurgery 16:215–217, 1985

    • Search Google Scholar
    • Export Citation
  • 14.

    Everett ED, , Eickhoff TC, & Simon RH: Cerebrospinal fluid shunt infections with anaerobic diphtheroids (Propionibacterium species). J Neurosurg 44:580584, 1976 Everett ED, Eickhoff TC, Simon RH: Cerebrospinal fluid shunt infections with anaerobic diphtheroids (Propionibacterium species). J Neurosurg 44:580–584, 1976

    • Search Google Scholar
    • Export Citation
  • 15.

    Gower DJ, , Lewis JC, & Kelly DL Jr: Sterile shunt malfunction. A scanning electron microscopic perspective. J Neurosurg 61:10791084, 1984 Gower DJ, Lewis JC, Kelly DL Jr: Sterile shunt malfunction. A scanning electron microscopic perspective. J Neurosurg 61:1079–1084, 1984

    • Search Google Scholar
    • Export Citation
  • 16.

    Greenberg HS, , Taren J, & Ensminger WD, et al: Benefit from and tolerance to continuous intrathecal infusion of morphine for intractable cancer pain. J Neurosurg 57:360364, 1982 Greenberg HS, Taren J, Ensminger WD, et al: Benefit from and tolerance to continuous intrathecal infusion of morphine for intractable cancer pain. J Neurosurg 57:360–364, 1982

    • Search Google Scholar
    • Export Citation
  • 17.

    James HE, & Tibbs PA: Diverse clinical applications of percutaneous lumboperitoneal shunts. Neurosurgery 8:3942, 1981 James HE, Tibbs PA: Diverse clinical applications of percutaneous lumboperitoneal shunts. Neurosurgery 8:39–42, 1981

    • Search Google Scholar
    • Export Citation
  • 18.

    Meisler DM, & Mandelbaum S: Propionibacterium-associated endophthalmitis after extracapsular cataract extraction. Review of reported cases. Ophthalmology 96:5461, 1989 Meisler DM, Mandelbaum S: Propionibacterium-associated endophthalmitis after extracapsular cataract extraction. Review of reported cases. Ophthalmology 96:54–61, 1989

    • Search Google Scholar
    • Export Citation
  • 19.

    Murphy TM, , Hinds S, & Cherry D: Intraspinal narcotics: nonmalignant pain. Acta Anaesthesiol Scand Suppl 85:7576, 1987 Murphy TM, Hinds S, Cherry D: Intraspinal narcotics: nonmalignant pain. Acta Anaesthesiol Scand Suppl 85:75–76, 1987

    • Search Google Scholar
    • Export Citation
  • 20.

    North RB, , Cutchis PN, & Epstein JA, et al: Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience. Neurosurgery 29:778784, 1991 North RB, Cutchis PN, Epstein JA, et al: Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience. Neurosurgery 29:778–784, 1991

    • Search Google Scholar
    • Export Citation
  • 21.

    Onofrio BM, & Yaksh TL: Long-term pain relief produced by intrathecal morphine infusion in 53 patients. J Neurosurg 72:200209, 1990 Onofrio BM, Yaksh TL: Long-term pain relief produced by intrathecal morphine infusion in 53 patients. J Neurosurg 72:200–209, 1990

    • Search Google Scholar
    • Export Citation
  • 22.

    Onofrio BM, , Yaksh TL, & Arnold PG: Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin. Mayo Clin Proc 56:516520, 1981 Onofrio BM, Yaksh TL, Arnold PG: Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin. Mayo Clin Proc 56:516–520, 1981

    • Search Google Scholar
    • Export Citation
  • 23.

    Penn RD, & Paice JA: Chronic intrathecal morphine for intractable pain. J Neurosurg 67:182186, 1987 Penn RD, Paice JA: Chronic intrathecal morphine for intractable pain. J Neurosurg 67:182–186, 1987

    • Search Google Scholar
    • Export Citation
  • 24.

    Pivetti-Pezzi P, & Accorint M: Propionibacterium endophthalmitis. Ophthalmology 99:17531754, 1992 (Letter) Pivetti-Pezzi P, Accorint M: Propionibacterium endophthalmitis. Ophthalmology 99:1753–1754, 1992 (Letter)

    • Search Google Scholar
    • Export Citation
  • 25.

    Rekate HL, , Ruch T, & Nulsen FE: Diphtheroid infections of cerebrospinal fluid shunts. The changing pattern of shunt infection in Cleveland. J Neurosurg 52:553555, 1980 Rekate HL, Ruch T, Nulsen FE: Diphtheroid infections of cerebrospinal fluid shunts. The changing pattern of shunt infection in Cleveland. J Neurosurg 52:553–555, 1980

    • Search Google Scholar
    • Export Citation
  • 26.

    Rodan BA, , Cohen FL, & Bean WJ, et al: Fibrous mass complicating epidural morphine infusion. Neurosurgery 16:6870, 1985 Rodan BA, Cohen FL, Bean WJ, et al: Fibrous mass complicating epidural morphine infusion. Neurosurgery 16:68–70, 1985

    • Search Google Scholar
    • Export Citation
  • 27.

    Shellock FG, , Litwer CA, & Kanal E: Magnetic resonance imaging: bioeffects, safety and patient management. Rev Magn Res Med 4:2163, 1992 Shellock FG, Litwer CA, Kanal E: Magnetic resonance imaging: bioeffects, safety and patient management. Rev Magn Res Med 4:21–63, 1992

    • Search Google Scholar
    • Export Citation
  • 28.

    Sjöberg M, , Karlsson PA, & Nordborg C, et al: Neuropathologic findings after long-term intrathecal infusion of morphine and bupivacaine for pain treatment in cancer patients. Anesthesiology 76:173182, 1992 Sjöberg M, Karlsson PA, Nordborg C, et al: Neuropathologic findings after long-term intrathecal infusion of morphine and bupivacaine for pain treatment in cancer patients. Anesthesiology 76:173–182, 1992

    • Search Google Scholar
    • Export Citation
  • 29.

    Von Roemeling R, , Lanning RM, & Eames FA: MR imaging of patients with implanted drug infusion pumps. J Magn Reson Imaging 1:7781, 1991 Von Roemeling R, Lanning RM, Eames FA: MR imaging of patients with implanted drug infusion pumps. J Magn Reson Imaging 1:77–81, 1991

    • Search Google Scholar
    • Export Citation
  • 30.

    Wang BC, , Hillman DE, & Spielholz NI, et al: Chronic neurological deficits and Nesacaine-CE—an effect of the anesthetic 2-chloroprocaine, or the antioxidant, sodium bisulfite? Anesth Analg 63:445447, 1984 Wang BC, Hillman DE, Spielholz NI, et al: Chronic neurological deficits and Nesacaine-CE—an effect of the anesthetic 2-chloroprocaine, or the antioxidant, sodium bisulfite? Anesth Analg 63:445–447, 1984

    • Search Google Scholar
    • Export Citation
  • 31.

    Zambrano W, , Flynn HW Jr, & Pflugfleder SG, et al: Management options for Proprionibacterium acnes endophthalmitis. Ophthalmology 96:11001105, 1989 Zambrano W, Flynn HW Jr, Pflugfleder SG, et al: Management options for Proprionibacterium acnes endophthalmitis. Ophthalmology 96:1100–1105, 1989

    • Search Google Scholar
    • Export Citation

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