A Rare Case of Pathologic Calcification Within an Intrathecal Pain Pump Pocket

Case Diagnosis: This is a novel finding of a calcified surgical pocket surrounding an intrathecal pain pump pocket in a relatively healthy patient.

Case Description: This is a 58-year-old relatively healthy male with history of motorcycle accident in 2007 status post L4-S1 fusion complicated by post laminectomy syndrome. Persistent pain resulted in placement of intrathecal pain (ITP) pump and spinal cord stimulator (SCS). In February 2023, his ITP pump and SCS required replacement due to both being at end of life. There were no signs or symptoms of infection, abnormality, or hardware malfunction. Preoperative x-rays of the lumbar spine and pelvis were obtained, both without radiographic evidence of concern. During the replacement procedure, white milky fluid was present with extensive calcifications along the pocket, pump, and catheter. There was a small amount of calcification near his SCS implantable pulse generator.

Discussion: With the extent of calcification surrounding the ITP pump, pocket, and catheter, this case illustrates the potential impingement effect on administration of intrathecal medication or SCS neuromodulation. Documentation of this complication in the setting of ITP pump and SCS implantation is minimal, leading one to believe the frequency with these implantable devices is low.

Setting: Outpatient Pain Clinic and Hospital Operating Room

Assessment/Results: The fluid within the pocket and calcifications along the pocket and pump were sent to lab from the OR, confirming diffuse calcifications without evidence of infection or neoplasm. The patient never experienced a lapse in pain control and there was intrathecal morphine dripping from the catheter when disconnected from the pump, both suggesting the ITP was still functioning appropriately in this case.

Conclusion: Pathologic calcification within the surgical pockets of ITP pumps and SCS are rare but can occur. More investigation into incidence, risk factors, and preventative strategies is warranted to explore pathologic calcification in the setting of ITP pumps and SCS.