Publication
Catheter-tip granulomas associated with intrathecal drug delivery
– a two-center experience
Presentation - May 14, 2014
Kratzsch Tobias, Stienen Martin N., Reck T., Hildebrandt Gerhard, Hoederath Petra
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Brief description/objective
Objective
Intrathecal (IT) infusion therapy via implanted pumps is an effective treatment modality to alleviate chronic pain and/or spasticity after non-invasive treatment has failed. Long-time use may cause formation of noninfectious inflammatory masses at the tip of the intrathecal catheter (=catheter-tip granulomas (CG)), possibly leading to neurological deficits and/or catheter revision. We here aimed to identify risk factors for CG-formation.
Methods
We reviewed charts of patient treated at two Swiss centers (Kantonsspital St. Gallen, Swiss Paraplegic Centre Nottwil) between 01/1994 – 10/2013. Collected data were age at operation, gender, smoking status, previous spinal operations, spinal level of catheter tip, clinical symptoms, catheter testing with contrast agent, applied drug and drug combinations, drug concentration, cumulative daily drug dosages, as well as changes in daily drug dosages.
Results
Eleven patients with CG (mean age at index surgery 51.9 years) were identified; 54 patients (48.6 years; p=.662) without CG served as controls. More patients with CG (46%) had catheter endings in the middle thoracic spine (Th4-8) than controls (6.5%; p=.005), and tended to have more previous spinal surgeries (73% vs. 40%, p=.089). The difference in the duration of intrathecal drug application until CG formation was not significant to the control group (7.0 vs. 5.3 years, p=.303). Chronic refractory pain was the underlying symptom in 100% of patients with CG (vs. 57% of controls; p=.012), whereas patients with spasticity as main symptom were less likely to develop CG (0% vs. 44%, p=.005). Thus, patients with CG received more IT-morphine (73% vs. 20%; p=.001). Still, application of IT-clonidine was likewise more frequent in the CG group (55% vs. 26%, p=.079). Catheter testing with contrast agent was performed more often in patients with CG (73% vs. 41%; p=.093). Smoking could not be confirmed as risk factor for CG formation.
Conclusions
Our patient cohort with CG differed in some distinct features, of which some are potentially modifiable. This information should promote future endeavors for prevention of catheter-tip granulomas.