Background: Intrathecal catheter placement has long-term therapeutic benefits in the
management of chronic, intractable pain. Despite the diverse clinical applicability and rising
prevalence of implantable drug delivery systems in pain medicine, the spectrum of complications
associated with intrathecal catheterization remains largely understudied and underreported in
the literature.
Objective: To report a case of thoracic nerve root entrapment resulting from intrathecal
catheter migration.
Study Design: Case report.
Setting: Inpatient hospital service.
Results/Case Report: A 60-year-old man status post implanted intrathecal (IT) catheter for
intractable low back pain secondary to failed back surgery syndrome returned to the operating
room for removal of IT pump trial catheter after experiencing relapse of preoperative pain
and pump occlusion. Initial attempt at ambulatory removal of the catheter was aborted after
the patient reported acute onset of lower extremity radiculopathic pain during the extraction.
Noncontrast computed tomography (CT) subsequently revealed that the catheter had ascended
and coiled around the T10 nerve root. The patient was taken back to the operating room for
removal of the catheter under fluoroscopic guidance, with possible laminectomy for direct
visualization. Removal was ultimately achieved with slow continuous tension, with complete
resolution of the patient’s new radicular symptoms.
Limitations: This report describes a single case report.
Conclusion: This case demonstrates that any existing loops in the intrathecal catheter during
initial implantation should be immediately re-addressed, as they can precipitate nerve root
entrapment and irritation. Reduction of the loop or extrication of the catheter should be
attempted under continuous fluoroscopic guidance to prevent further neurosurgical morbidity.
Key words: Implantable drug delivery system, intrathecal, catheter migration, postoperative
complications, looping, fluoroscopy
A combination of pathologies - facet joint synovial cyst, epidural lipomatosis and conjoined nerve root anomaly in the lumbar spine of a 45-year-old patient. A case report
