Koeck K, Grossauer S, Trummer M and Kleinert R
Intrathecal drug delivery systems are an option for selected patients with chronic pain. Complications such as intrathecal catheter-tip inflammatory masses are already reported in literature. In the present case report we describe a patient suffering from neuropathic pain located on the anterior aspects of both thighs following failed back surgery. Two years after implantation of an intrathecal morphine pump system the patient experienced symptoms of a spinal cord compression with increasing radicular pain, especially after application of morphine bolus. Within this time frame the average daily intrathecal morphine hydrochloride dose was 3.2 mg per day and the total neuraxial morphine hydrochloride dose was 2460 mg. Magnetic resonance imaging revealed spinal cord compression from an epidural mass measuring 13×11×10 millimeters, originating from an epidural dislocation of the intrathecal catheter. After surgical removal of the mass, histological examination confirmed a disseminated formation of a granuloma. What makes this case so special, is the fact that the granuloma is not located intrathecally, but in the epidural space (epidural granuloma). The formation of a purely epidural granuloma due to a dislocated catheter tip has - according to our research - not been reported about up to the present.