Spinal Cord Compression Complicating Subarachnoid Infusion of Morphine: Case Report and Laboratory Experience

Abstract The intraspinal administration of morphine has been employed increasingly in the management of intractable pain of malignant as well as benign origin. We have encountered a previously unreported clinical complication: spinal cord compression by an inflammatory tissue mass surrounding a subarachnoid infusion catheter administering morphine. leading to paraplegia. The patient was referred to our institution after catheter and pump implantation for chronic, intractable pain associated with pre-existing lumbar arachnoid fibrosis, after multiple myelograms and surgeries. The patient may. therefore, have had an underlying propensity to foreign body reactions. We have encountered a similar phenomenon, however, in a canine laboratory model. The pathological features in both our patient and our laboratory preparation, with inflammatory tissue masses around the tip of the catheter but not around proximal subarachnoid segments, suggest an effect related to infusion. as opposed to infection or the presence of the catheter. We review the pathological features in both settings and the pertinent literature.

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IgG4-Related Sclerosing Disease Causing Spinal Cord Compression: The First Reported Case in Literature

Case Reports in Immunology ◽

10.1155/2019/3618510 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Nooraldin Merza ◽

Ahmed Taha ◽

John Lung ◽

Anthony W. Benderman ◽

Stephen E. Wright

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cervical Spinal Cord ◽

Cord Compression ◽

Neurological Deficits ◽

Pathological Examination ◽

Tissue Mass ◽

Systemic Steroids ◽

First Case

Immunoglobulin G4-related disease (IgG4-RD) is known for forming soft tissue mass lesions that may have compressive effects. It is an extremely rare disease that most frequently affects the pancreas causing autoimmune pancreatitis. It can also affect the gallbladder, salivary glands, and lacrimal glands causing respective organ-specific complications. In our report, we describe an IgG4-RD case that affected the spinal cord. A 60-year-old female presented with cervical spinal cord compression caused by IgG4-RD leading to several neurological deficits. Pathological examination of the excisional biopsy of the mass revealed dense lymphoplasmacytic cells infiltration and stromal fibrosis with IgG4 and plasma cells. The patient showed a dramatic response to the administration of systemic steroids with almost resolution of her neurological symptoms. This case highlights the first case in literature for IgG4-RD of the extradural tissue causing spinal compression. Hereby, we also demonstrate the dramatic response of IgG4-RD to the administration of systemic steroids as the patient had no recurrence after 5 years of close follow-up, the longest reported period of follow-up reported in the literature to date.

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Spinal Cord Compression from Metastasizing Cicatrial Carcinoma: A Case Report

Neurosurgery ◽

10.1227/00006123-198710000-00020 ◽

1987 ◽

Vol 21 (4) ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Peter John Gilling ◽

Martin Richard MacFarlane ◽

Jeffrey Charles Rhode

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Soft Tissue Mass ◽

Relevant Literature ◽

Clinical History ◽

Cord Compression ◽

Vertebral Collapse ◽

Tissue Mass ◽

Burn Scar ◽

Progressive Paraparesis

Abstract Spinal cord compression from a metastasizing burn scar cancer has not previously been reported. A patient with rapidly progressive paraparesis associated with vertebral collapse and an extradural soft tissue mass of undetermined origin is presented. The clinical history, radiological diagnosis, and histological features of cicatrial carcinoma are discussed along with a brief review of the relevant literature. (Neurosurgery 21:553-557, 1987)

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Metastatic spinal tumors

Neurosurgical FOCUS ◽

10.3171/foc.2001.11.6.2 ◽

2001 ◽

Vol 11 (6) ◽

pp. 1-9 ◽

Cited By ~ 66

Author(s):

Robert F. Heary ◽

Christopher M. Bono

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

External Beam Radiotherapy ◽

Cord Compression ◽

Spinal Tumors ◽

Surgical Approaches ◽

Vascular Tumors ◽

Preoperative Embolization ◽

Intractable Pain ◽

Primary Malignancy

Metastatic spinal tumors are the most common type of malignant lesions of the spine. Prompt diagnosis and identification of the primary malignancy is crucial to overall treatment. Numerous factors affect outcome including the nature of the primary cancer, the number of lesions, the presence of distant nonskeletal metastases, and the presence and/or severity of spinal cord compression. Initial management consists of chemotherapy, external beam radiotherapy, and external orthoses. Surgical intervention must be carefully considered in each case. Patients expected to live longer than 12 weeks should be considered as candidates for surgery. Indications for surgery include intractable pain, spinal cord compression, and the need for stabilization of impending pathological fractures. Whereas various surgical approaches have been advocated, anterior-approach surgery is the most accepted procedure for spinal cord decompression. Posterior approaches have also been used with success, but they require longer-length fusion. To obtain a stable fixation, the placement of instrumentation, in conjunction with judicious use of polymethylmethacrylate augmentation, is crucial. Preoperative embolization should be considered in patients with extremely vascular tumors such as renal cell carcinoma. Vertebroplasty, a newly described procedure in which the metastatic spinal lesions are treated via a percutaneous approach, may be indicated in selected cases of intractable pain caused by non- or minimally fractured vertebrae.

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