A Novel Association Between Intrathecal Drug Administration and Arachnoiditis Ossificans.

A Novel Association Between Intrathecal Drug Administration and Arachnoiditis Ossificans.

World Neurosurg. 2018 May 07;:

Authors: Ward M, Mammis A, Barry MT, Heary RF

Abstract
We present a case of delayed progression of adhesive arachnoiditis to arachnoiditis ossificans (AO) in a patient being treated with a high dose polypharmaceutical intrathecal regimen. The patient is a 39-year-old Caucasian male who was implanted with an intrathecal pump in 2006 to control severe low back pain and administered intrathecal pain medication for a period of 10 years. In 2016, he developed new onset radicular pain and worsened sensation in his lower extremities. A CT scan of the lumbar spine at that time demonstrated profound calcification of the arachnoid consistent with a diagnosis of AO. It was presumed that prolonged high dose intrathecal medication precipitated this condition and his intrathecal medications were titrated down with removal of the pump. It is unlikely that his condition occurred as a result of prior surgery, with the more likely cause being hyperplasia of the spinal arachnoid, leading to scarring and calcification, due to the high dose intrathecal regimen. This case highlights the delayed progression from stable arachnoiditis to AO concurring with a regimen of high dose intrathecal medications. Clinicians should closely monitor patients undergoing intrathecal drug administration, particularly at elevated doses, for indications of damage to the spinal arachnoid mater.

PMID: 29747017 [PubMed - as supplied by publisher]

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