Management of Intrathecal Catheter-Tip Inflammatory Masses: An Updated 2007 Consensus Statement From An Expert Panel

Increased Spasticity From a Fracture in the Baclofen Catheter Caused by Charcot Spine: Case Report

“…The use of intrathecal opioid and nonopioid medications has been associated with the development of catheter granulomas, which occur with a frequency of 0.1% to 5%, [20][21][22][23][24] as it did in this case, most likely because of shearing and inflammation at the Charcot level. It has been postulated that the use of intrathecal medication can ultimately lead to spinal deformity and instability over time.…”

Catheter Obstruction of Intrathecal Drug Administration System -A Case Report-

“…First, since the concentration and dose of the medication is higher and the flow rate is lower, there is a high possibility of mass formation; thus, it is recommended that the maximum concentration should be 20 mg/ml, and the maximum dose should not to exceed 15 mg/d [6]. Since the CSF space is wider, it lowers the possibility of a granuloma; therefore, it is best to position the catheter tip at T7-T10 or L1-L2 where the CSF space is wide [6]. If the catheter tip is located lower than the conus medullaris, it can minimize neurological abnormalities even when a mass is formed [11].…”

“…Regarding the complications of ITDAS, catheter obstruction is a very serious complication, and there are clinical recommendations on the concentration and quantity of opioids to prevent its occurrence [6]. Despite following the recommendations that prevent catheter tip mass formation, the authors experienced a case where the catheter was obstructed and drug administration was stopped because of a mass in the side hole and lumen and hence, are reporting this case with a literature review.…”

Ziconotide Combination Intrathecal Therapy: Rationale and Evidence

“…No published cases of granuloma development have been associated with ziconotide treatment. 33 During the first 3 weeks of treatment, the ziconotide dose was titrated upward each week in increments of 0.5 mcg/wk, and the dose of IT morphine was reduced. After 2 months of combination ziconotide and morphine therapy, the patient reported a pain score of 4, improved function, and greater mobility.…”