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Persistent Spinal Headache After Removal of Intrathecal Drug Delivery System: A Case Report and Review of Literature.

Kurnutala LN, Kim D, Sayeed H, Sibai N - Anesth Pain Med (2015)

Bottom Line: Intrathecal drug delivery system (IDDS) was initially used for the management of chronic malignant pain; it has since been used to manage pain from other nonmalignant conditions as well.Conservative management is successful in the vast majority of patients with spinal headache.Interventional procedures are required in a small fraction of patients for symptomatic relief.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, USA.

ABSTRACT

Introduction: To report and discuss the spinal headache following insertion and removal of intrathecal drug delivery system in patients with chronic pain disorders.

Case presentation: Intrathecal drug delivery system (IDDS) was initially used for the management of chronic malignant pain; it has since been used to manage pain from other nonmalignant conditions as well. Spinal headache is one of the complications during the trial, permanent placement and after removal of intrathecal drug delivery catheter systems. A 48-year-male patient with chronic pain disorder developed a refractory spinal headache after removing the intrathecal drug delivery system requiring a surgical intervention to resolve the problem.

Conclusions: Conservative management is successful in the vast majority of patients with spinal headache. Interventional procedures are required in a small fraction of patients for symptomatic relief.

No MeSH data available.


Related in: MedlinePlus

Paraspinal Open Wound 10 Days After Surgical Removal of IDDS System With Clear Discharge - CSF
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fig22990: Paraspinal Open Wound 10 Days After Surgical Removal of IDDS System With Clear Discharge - CSF

Mentions: The patient presented 10 days after explantation of the intrathecal pump to the emergency room with persistent headache worsened with sitting and standing positions. He also had wet dressing over the paraspinal wound. On examination, clear fluid (cerebrospinal fluid-CSF) was noticed leaking from the paraspinal wound (Figure 2). Initially, the patient was managed conservatively with bed rest, oral analgesics, hydration and caffeine for 24 hours (3-6). His symptoms did not resolve and he was referred to neurosurgery for surgical management for persistent and significant CSF leak with severe headache and an open paraspinal surgical wound. He underwent bilateral laminectomies at L2 and L3 with exploration of lumbar wound and dura matter. Immediately after removing the inferior portion of the L2 lamina, the surgeon encountered a brisk CSF leak from a pinhole opening surrounded by ligament and scar tissue. Dural repair of the CSF leak was performed with a tiny piece of muscle using a stitch with 4-0 nylon suture. All the leakage immediately stopped at that point, and there was no extrusion of any rootlets or nerve material (7). The postoperative period was uneventful with complete relief of the headache.


Persistent Spinal Headache After Removal of Intrathecal Drug Delivery System: A Case Report and Review of Literature.

Kurnutala LN, Kim D, Sayeed H, Sibai N - Anesth Pain Med (2015)

Paraspinal Open Wound 10 Days After Surgical Removal of IDDS System With Clear Discharge - CSF
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644312&req=5

fig22990: Paraspinal Open Wound 10 Days After Surgical Removal of IDDS System With Clear Discharge - CSF
Mentions: The patient presented 10 days after explantation of the intrathecal pump to the emergency room with persistent headache worsened with sitting and standing positions. He also had wet dressing over the paraspinal wound. On examination, clear fluid (cerebrospinal fluid-CSF) was noticed leaking from the paraspinal wound (Figure 2). Initially, the patient was managed conservatively with bed rest, oral analgesics, hydration and caffeine for 24 hours (3-6). His symptoms did not resolve and he was referred to neurosurgery for surgical management for persistent and significant CSF leak with severe headache and an open paraspinal surgical wound. He underwent bilateral laminectomies at L2 and L3 with exploration of lumbar wound and dura matter. Immediately after removing the inferior portion of the L2 lamina, the surgeon encountered a brisk CSF leak from a pinhole opening surrounded by ligament and scar tissue. Dural repair of the CSF leak was performed with a tiny piece of muscle using a stitch with 4-0 nylon suture. All the leakage immediately stopped at that point, and there was no extrusion of any rootlets or nerve material (7). The postoperative period was uneventful with complete relief of the headache.

Bottom Line: Intrathecal drug delivery system (IDDS) was initially used for the management of chronic malignant pain; it has since been used to manage pain from other nonmalignant conditions as well.Conservative management is successful in the vast majority of patients with spinal headache.Interventional procedures are required in a small fraction of patients for symptomatic relief.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, USA.

ABSTRACT

Introduction: To report and discuss the spinal headache following insertion and removal of intrathecal drug delivery system in patients with chronic pain disorders.

Case presentation: Intrathecal drug delivery system (IDDS) was initially used for the management of chronic malignant pain; it has since been used to manage pain from other nonmalignant conditions as well. Spinal headache is one of the complications during the trial, permanent placement and after removal of intrathecal drug delivery catheter systems. A 48-year-male patient with chronic pain disorder developed a refractory spinal headache after removing the intrathecal drug delivery system requiring a surgical intervention to resolve the problem.

Conclusions: Conservative management is successful in the vast majority of patients with spinal headache. Interventional procedures are required in a small fraction of patients for symptomatic relief.

No MeSH data available.


Related in: MedlinePlus