Paraplegia in a Patient with an Intrathecal Catheter and a Spinal Cord Stimulator

Primary Hydromorphone-Related Intrathecal Catheter Tip Granulomas: Is There a Role for Dose and Concentration?

“…Since North et al reported the first granuloma formation in 1991 , there have been many articles describing inflammatory mass lesions at the tips of intrathecal catheters, mostly in the form of case reports or case series . Intrathecal catheter tip granulomas have been reported to occur at a rate of 0.5–3% of cases, though these numbers are believed to be conservative estimates of the actual prevalence .…”

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

“…A volume of 4 mL will spread epidurally to the level of C2 . Considering the narrow epidural margin present at the cervical level (average 3 mm), it is theoretically possible that the injection of higher volumes in the epidural space can involve a higher risk for dural puncture.…”

“…At the cervical level, the epidural space at C6–7 and C7–T1 is the widest, with an average dimension of 3 mm (1 to 4 mm) . At C7–T1, in the dorsal epidural space 1 to 2 mm of fat may be visible on MRI (rarely more than this), such that this level has somewhat more margin on interlaminar approach …”

Drug Adverse Events and System Complications of Intrathecal Opioid Delivery for Pain: Origins, Detection, Manifestations, and Management

“…In cases of long‐term catheter placement, a nonspecific reaction around the catheter tip may lead to the formation of an expanding, granulomatous mass at the tip of the catheter (1). Over time, the mass may lead to spinal cord compression with signs of myelopathy (52‐57).…”

“…Blount et al (54) reported three cases of intrathecal granulomas in patients who received intrathecal morphine delivery for 8–24 months. Three other single‐case reports have documented the existence of intrathecal masses or adhesive arachnoiditis and meningothelial hyperplasia in patients who received intrathecal drug delivery with an implanted pump (52,53,56). Because the etiology for the development of granulomatous masses around the tip of catheters is unknown, there are no measures that can be taken to prevent their development in the few patients who have this problem.…”