Cabbell K L, Taren J A, Sagher O
Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0338, USA.
Neurosurgery. 1998 May;42(5):1176-80; discussion 1180-1. doi: 10.1097/00006123-199805000-00142.
The use of chronic intrathecal morphine for the treatment of intractable, nonmalignant pain is becoming more prevalent. A rare but devastating complication of this therapy is the development of spinal cord compression secondary to the formation of intrathecal granulomas.
We report three cases of intrathecal granuloma formation in the thoracic subarachnoid space, associated with intrathecal morphine pumps. These three patients were receiving high doses of morphine to control their pain (25 mg/d, 28 mg/d, and 45 mg/d, respectively) when they presented with signs and symptoms of thoracic spinal cord compression. Myelography and postmyelographic computed tomography of the spine revealed masses causing spinal cord compression.
Two patients underwent thoracic laminectomies for resection of these masses, and the other patient had the intrathecal catheter removed. A pathological examination revealed sterile granulomas in the resected masses.
Intrathecal granulomas are likely to occur with increasing frequency as the use of chronic intrathecal morphine delivery increases in patients with nonmalignant pain. The cause of intrathecal granulomas is unknown, although it is likely that morphine plays a major role in their formation. We think that those patients receiving high doses of morphine are at greater risk for developing this complication.
长期鞘内注射吗啡用于治疗顽固性非恶性疼痛正变得越来越普遍。这种治疗方法一种罕见但极具破坏性的并发症是鞘内肉芽肿形成继发脊髓压迫。
我们报告3例发生于胸段蛛网膜下腔的鞘内肉芽肿形成病例，均与鞘内吗啡泵有关。这3例患者在出现胸段脊髓压迫的体征和症状时，正接受高剂量吗啡以控制疼痛（分别为25毫克/天、28毫克/天和45毫克/天）。脊髓造影及脊髓造影后脊柱计算机断层扫描显示有肿块导致脊髓压迫。
2例患者接受了胸椎椎板切除术以切除这些肿块，另1例患者拔除了鞘内导管。病理检查显示切除的肿块中有无菌性肉芽肿。
随着慢性鞘内注射吗啡在非恶性疼痛患者中的应用增加，鞘内肉芽肿的发生频率可能会上升。鞘内肉芽肿的病因尚不清楚，尽管吗啡很可能在其形成过程中起主要作用。我们认为接受高剂量吗啡的患者发生这种并发症的风险更高。
