Development of scoliosis following intrathecally placed opioid pump for chronic low back pain

Daniel Sciubba, Li Mei Lin, James E. Conway, Ali Bydon, Ziya L. Gokaslan, Khaled M Kebaish

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN. Case report. OBJECTIVE. To report a case and review the literature on development of scoliosis following intrathecally placed opioid pump for chronic low back pain. SUMMARY OF BACKGROUND DATA. Intrathecal opioid administration is a technique currently indicated for the management of chronic pain syndromes. Despite evidence of scoliosis occurring after baclofen pump insertion, there has been no evidence that development of scoliosis occurs following implantation of an intrathecally placed opioid pump for treatment of lower back pain (LBP). METHODS. A retrospective review of patients with adult onset scoliosis was performed at our institution. One patient was identified as showing significant scoliotic progression following implantation of an intrathecally placed opioid pump. Radiographs were analyzed to evaluate the magnitude and configuration of her kyphoscoliosis following pump insertion. RESULTS. A 50-year-old woman with intractable LBP underwent placement of a spinal cord stimulator (SCS) followed shortly by removal of the SCS and placement of an intrathecal opioid pump. Five years later, she presented with severe kyphoscoliosis involving a left thoracolumbar curve of 84° and sagittal balance of 158 mm. Because of intractable pain and progressive deformity, she underwent multilevel osteotomies, instrumented fusion, and replacement of her Dilaudid pump. Postoperative radiographs demonstrated a residual 23° thoracolumbar curve with restoration of her sagittal alignment. No major morbidity/mortality occurred with treatment. CONCLUSION. Although there may not be a direct correlation between implantation of an intrathecal opioid pump with subsequent development of adult onset scoliosis, deformity must be considered a potential sequela in patients treated with such neuromodulation.

Original languageEnglish (US)
JournalSpine
Volume32
Issue number24
DOIs
StatePublished - Nov 2007

Fingerprint

Scoliosis
Low Back Pain
Opioid Analgesics
Spinal Cord
Hydromorphone
Intractable Pain
Baclofen
Osteotomy
Chronic Pain
Morbidity
Mortality
Therapeutics

Keywords

  • Chronic pain
  • Deformity
  • Pain pump
  • Scoliosis
  • Spinal cord stimulation

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Development of scoliosis following intrathecally placed opioid pump for chronic low back pain. / Sciubba, Daniel; Lin, Li Mei; Conway, James E.; Bydon, Ali; Gokaslan, Ziya L.; Kebaish, Khaled M.

In: Spine, Vol. 32, No. 24, 11.2007.

Research output: Contribution to journalArticle

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abstract = "STUDY DESIGN. Case report. OBJECTIVE. To report a case and review the literature on development of scoliosis following intrathecally placed opioid pump for chronic low back pain. SUMMARY OF BACKGROUND DATA. Intrathecal opioid administration is a technique currently indicated for the management of chronic pain syndromes. Despite evidence of scoliosis occurring after baclofen pump insertion, there has been no evidence that development of scoliosis occurs following implantation of an intrathecally placed opioid pump for treatment of lower back pain (LBP). METHODS. A retrospective review of patients with adult onset scoliosis was performed at our institution. One patient was identified as showing significant scoliotic progression following implantation of an intrathecally placed opioid pump. Radiographs were analyzed to evaluate the magnitude and configuration of her kyphoscoliosis following pump insertion. RESULTS. A 50-year-old woman with intractable LBP underwent placement of a spinal cord stimulator (SCS) followed shortly by removal of the SCS and placement of an intrathecal opioid pump. Five years later, she presented with severe kyphoscoliosis involving a left thoracolumbar curve of 84° and sagittal balance of 158 mm. Because of intractable pain and progressive deformity, she underwent multilevel osteotomies, instrumented fusion, and replacement of her Dilaudid pump. Postoperative radiographs demonstrated a residual 23° thoracolumbar curve with restoration of her sagittal alignment. No major morbidity/mortality occurred with treatment. CONCLUSION. Although there may not be a direct correlation between implantation of an intrathecal opioid pump with subsequent development of adult onset scoliosis, deformity must be considered a potential sequela in patients treated with such neuromodulation.",
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AB - STUDY DESIGN. Case report. OBJECTIVE. To report a case and review the literature on development of scoliosis following intrathecally placed opioid pump for chronic low back pain. SUMMARY OF BACKGROUND DATA. Intrathecal opioid administration is a technique currently indicated for the management of chronic pain syndromes. Despite evidence of scoliosis occurring after baclofen pump insertion, there has been no evidence that development of scoliosis occurs following implantation of an intrathecally placed opioid pump for treatment of lower back pain (LBP). METHODS. A retrospective review of patients with adult onset scoliosis was performed at our institution. One patient was identified as showing significant scoliotic progression following implantation of an intrathecally placed opioid pump. Radiographs were analyzed to evaluate the magnitude and configuration of her kyphoscoliosis following pump insertion. RESULTS. A 50-year-old woman with intractable LBP underwent placement of a spinal cord stimulator (SCS) followed shortly by removal of the SCS and placement of an intrathecal opioid pump. Five years later, she presented with severe kyphoscoliosis involving a left thoracolumbar curve of 84° and sagittal balance of 158 mm. Because of intractable pain and progressive deformity, she underwent multilevel osteotomies, instrumented fusion, and replacement of her Dilaudid pump. Postoperative radiographs demonstrated a residual 23° thoracolumbar curve with restoration of her sagittal alignment. No major morbidity/mortality occurred with treatment. CONCLUSION. Although there may not be a direct correlation between implantation of an intrathecal opioid pump with subsequent development of adult onset scoliosis, deformity must be considered a potential sequela in patients treated with such neuromodulation.

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