What is Inflammatory Granuloma?

Question: What is Inflammatory Granuloma?

Inflammatory granuloma is one complication of implanted drug delivery systems.

Answer: Inflammatory granuloma, a rare complication that may happen when you have a drug delivery pump implanted, is the development of an inflammatory mass right where the catheter is inserted. Inflammatory granuloma occurs more frequently when the drug delivery system is implanted in the intrathecal space (inside the layers of the spinal cord itself), as opposed to the epidural space (just outside the spinal cord). Approximately 1% of patients who are at risk for inflammatory granuloma due to drug deliver system implantation actually develop the condition.

Some of the early signs of inflammatory granuloma include loss of sensation and pain in the dermatome that corresponds to the place in the spinal cord where the catheter was inserted. Later signs include paralysis and bowel and/or baldder dysfunction. If your doctor determines that you have inflammatory granuloma, she will stop the drug delivery immediately, and you may need surgery.

According to Dr. Sudhir Diwan, director of the division of pain medicine at Weil-Cornell Medical College, inflammatory granuloma may show up 6 months after the catheter has been placed. But it also may take years before there are symptoms. Dr. Diwan says that inflammatory granuloma is related to the dosage or concentration of morphine delivered by the pump. He adds, "we like to place the catheter lower down, below the L-1 vertebra , as there is no spinal cord in that area, which minimizes injury."

Prevention may be accomplished by changing the medications delivered by the pump, using more than one area for catheter insertion and/or not allowing dosages of morphine and hydromorphone to get too high.

_{Sources:
Dr. Sudhir Diwan, MD. Director, Pain Medicine Fellowship Program and Director, Division of Pain Medicine at Weil-Cornell Medical College of Cornell University. Telephone Interview. May 2008.}

Patrick J. McIntyre, MD, JD; Timothy R. Deer, MDb; and Salim M. Hayek, MD, PhD. Complications of spinal infusion therapies Techniques in Regional Anesthesia and Pain Management Volume 11, Issue 3, July 2007, Complications of Interventional Pain Procedures

Stedman's Medical Dictionary. 28th ed. Lippincott Williams & Wilkins. Baltimore. 2006.