• Jing L Han, Daniel B Loriaux, Caroline Tybout, Merritt D Kinon, Shervin Rahimpour, Scott L Runyon, Thomas J Hopkins, Richard L Boortz-Marx, and Shivanand P Lad.
• Department of Neurosurgery, Duke University Medical Center, Durham, NC.
• Pain Physician. 2016 Mar 1; 19 (3): E499-504.

BackgroundIntrathecal 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.ObjectiveTo report a case of thoracic nerve root entrapment resulting from intrathecal catheter migration.Study DesignCase report.SettingInpatient hospital service.Results/ Case ReportA 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.LimitationsThis report describes a single case report.ConclusionThis 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.

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