Age: 62
Sex: Male
History:
- 1992 -- Weakness and numbness in left leg.
- MRI -- ? AVM mid dorsal spine. Angio normal. Conservative.
MRI of T-spine showing AVM of mid T-spine
- 1993 -- Deterioration. Angio repeated. AVM seen. Excised.
- Intractable pain left leg post-op.
- Unresponsive to narcotics.
- 1995 -- Morphine pump implanted at T11-12 at a dose of 5mg daily. Good control.
- 1998 -- Morphine gradually up to 17mg daily for good pain control.
- X-Ray now shows catheter at L2-3.
X-Ray of Lumbar spine showing catheter at L2-3 level when 17mg of morphine was required daily.
- Catheter re-positioned to T7-8. Morphine requirement dropped to 6mg daily.
X-Ray of T-spine showing catheter at T7-8. Morphine requirement dropped.
QUESTION:
- Is this spontaneous remission cause a drop in the dose requirement of Morphine to control his pain?
- Is it related to the repositioning of the tip of the intrathecal catheter in relation to the surgical pathology?
- Does it really make a difference in the degree of pain control in intrathecal Morphine infusion where the catheter is, since the drug diffuses throughout the CSF?
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