2018 FSA Posters

P011: NEW MRI FINDINGS ALTER IDD PLANNING IN AN ONCOLOGY PATIENT
Oleksiy Lelyanov, DO, Oren Ambalu, MD, William Grubb, MD, DDS; Rutgers/RWJMS

71yo male with history of prostate cancer with metastasis to left pelvic bones was referred to NJPI/Rutgers to be evaluated for placement of Intrathecal Drug Delivery system. He is status post total prostatectomy in 2015 and is currently on chemotherapy.  Patient’s primary complaint was lancinating and sharp pain, intermittent, involving his left leg associated with paresthesia, numbness, and weakness, VAS 9/10. Patient’s current medical regimen included Oxycontin 60mg PO BID and Oxycodone 10mg q6 hours PRN for breakthrough pain.

The patient and his family were educated on the device and the procedure and understood all the associated risks. In anticipation for the procedure, a lumbar MRI was ordered. The MRI revealed extensive osseous metastatic disease from L2-S2 with paraspinal and epidural extension of the tumor causing severe spinal stenosis (see Image 1). In light of these findings, the decision to pursue radiation therapy prior to initiation of intrathecal therapy was made.

Although there is a number of publications (see ref 1) available attempting to outline guidelines for evaluating and preparing patients for intrathecal therapy, the importance of obtaining a preoperative MRI is not stressed. As demonstrated by the case of the patient, a recent MRI should be obtained.

In evaluating patients for Intrathecal Drug delivery therapy it is important to assess for a number of criteria.
1) The extent of the disease and co-morbidities, as well as life expectancy of the patient needs to be explored.
2) Family support is integral to the ability of the patient to successfully utilize Intrathecal therapy.

3) Patient’s coagulation profile needs to be evaluated and maintained.

4) Complete blood count in patients on chemotherapy should be assessed and corrected.

5) A recent MRI, preferably less than 2 weeks old, should be obtained

Reference:

Deer et al. Comprehensive consensus based guidelines on intrathecal drug delivery systems in the treatment of pain caused by cancer pain. Pain Physician 2011, May-Jun 14(3)