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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Catheter-tip granulomas associated with intrathecal drug delivery – a two-center experience

Meeting Abstract

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  • Tobias Kratzsch - Klinik für Neurochirurgie, Kantonsspital St. Gallen, St. Gallen, Schweiz
  • Martin N. Stienen - Klinik für Neurochirurgie, Kantonsspital St. Gallen, St. Gallen, Schweiz
  • Tim Reck - Schweizer Paraplegiker-Zentrum, Zentrum für Schmerzmedizin, Nottwil, Schweiz
  • Gerhard Hildebrandt - Klinik für Neurochirurgie, Kantonsspital St. Gallen, St. Gallen, Schweiz
  • Petra Hoederath - Klinik für Neurochirurgie, Kantonsspital St. Gallen, St. Gallen, Schweiz

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.11.02

doi: 10.3205/14dgnc327, urn:nbn:de:0183-14dgnc3279

Published: May 13, 2014

© 2014 Kratzsch et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

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 non-infectious 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.

Method: We reviewed charts of patient treated at two Swiss centers (Kantonsspital St. Gallen, Swiss Paraplegic Centre Nottwil) between 01/1994 and 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 IT-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.