Introduction: Intrathecal pain pumps (ITP) are commonly used for managing severe cancer-related and chronic pain, particularly in cases of spinal metastasis. Despite their prevalence, complications related to intrathecal catheterization remain underexplored in current literature, with risks such as catheter migration presenting unique clinical challenges.
Methods: This report describes the case of a 73-year-old male with stage IV non-small cell lung cancer and metastatic involvement of the lumbar spine at L4. Initial management included immunotherapy and stereotactic body radiotherapy, followed by percutaneous instrumented fusion (L3-L5) and ITP catheter insertion at L2/3 to alleviate intractable pain.
Results: Although the ITP catheter demonstrated initial functional positioning, subsequent imaging revealed migration complications, including a loop formation at T10-11 and extradural catheter tip lodging into the posterior cortex of the L2 vertebral body requiring open surgical repositioning of the catheter into the thecal sac. The patient experienced notable improvement in pain control following reposition of the catheter in the thecal sac.
Conclusion : This case underscores the importance of timely, vigilant follow-up and imaging to detect intrathecal catheter migration. Early detection and intervention are critical to maintaining effective pain management in patients with complex spinal metastasis.