{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T05:35:00Z","timestamp":1774330500110,"version":"3.50.1"},"reference-count":9,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2021,8,19]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Cerebral spinal fluid (CSF) dynamics are complex and changes in spinal anatomy may influence the rostrocaudal movement of intrathecal medications. We present the first reported case demonstrating that acute cervical spinal stenosis may impede the distribution of adjacent intrathecal medications, and that correction of such stenosis and the resulting changes in CSF flow may necessitate significant adjustments in the intrathecal infusates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>We present a case of a 60-year-old male patient with a cervicothoracic intrathecal pump (ITP) infusing morphine, bupivacaine, and baclofen for chronic neck pain. The alert and oriented patient had a recent fall resulting in an acute severe cervical stenosis and cord compression which required urgent surgical decompression. Postoperatively, after the cervical decompression, the patient had significant altered mental status requiring a naloxone infusion. Multiple attempts to reduce the naloxone infusion were initially not successful due to worsened somnolence. The previously tolerated ITP medications were continuously reduced over the next 14 days, allowing concomitant decrease and eventual cessation of the naloxone infusion while maintaining patient mental status. The only opioids the patient received during this period were from the ITP.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This case presents clinical evidence that severe spinal stenosis may impede the rostral CSF distribution of intrathecal medications. Intrathecal medications previously tolerated by patients prior to decompression may need to be significantly reduced in the postoperative period.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2021-103041","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T12:19:56Z","timestamp":1630930796000},"page":"1100-1102","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Severe altered mentation due to cervicothoracic intrathecal pump after correction of cervical stenosis: a case report"],"prefix":"10.1136","volume":"46","author":[{"given":"Chinar","family":"Sanghvi","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiffany","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony L","family":"Yaksh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of California San Diego School of Medicine, La Jolla, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J","family":"Copenhaver","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric O","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California Davis Health System, Sacramento, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8892-072X","authenticated-orcid":false,"given":"Michael J","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,9,6]]},"reference":[{"key":"2025101112052412000_46.12.1100.1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200607000-00027"},{"key":"2025101112052412000_46.12.1100.2","doi-asserted-by":"publisher","DOI":"10.1097\/00004424-200107000-00003"},{"key":"2025101112052412000_46.12.1100.3","doi-asserted-by":"publisher","DOI":"10.1186\/2045-8118-10-36"},{"key":"2025101112052412000_46.12.1100.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0212239","article-title":"Characterization of intrathecal cerebrospinal fluid geometry and dynamics in cynomolgus monkeys (Macaca fascicularis) by magnetic resonance imaging","volume":"14","author":"Khani","year":"2019","journal-title":"PLoS One"},{"key":"2025101112052412000_46.12.1100.5","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/00006123-199308000-00007","article-title":"The distribution of medication along the spinal canal after chronic intrathecal administration","volume":"33","author":"Kroin","year":"1993","journal-title":"Neurosurgery"},{"key":"2025101112052412000_46.12.1100.6","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181c38da5"},{"key":"2025101112052412000_46.12.1100.7","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s00586-016-4874-9","article-title":"Cervical compressive myelopathy: flow analysis of cerebrospinal fluid using phase-contrast magnetic resonance imaging","volume":"26","author":"Bae","year":"2017","journal-title":"Eur Spine J"},{"key":"2025101112052412000_46.12.1100.8","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1213\/ANE.0000000000002071","article-title":"Modeling spinal intrathecal drug distribution: the challenge of defining and predicting cerebrospinal fluid dynamics","volume":"124","author":"Bert","year":"2017","journal-title":"Anesth Analg"},{"key":"2025101112052412000_46.12.1100.9","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1213\/ANE.0000000000002011","article-title":"Computational and in vitro experimental investigation of intrathecal drug distribution: parametric study of the effect of injection volume, cerebrospinal fluid Pulsatility, and drug uptake","volume":"124","author":"Tangen","year":"2017","journal-title":"Anesth Analg"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2021-103041","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:05:33Z","timestamp":1760209533000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2021-103041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,6]]},"references-count":9,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,11,19]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/rapm-2021-103041"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2021-103041","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,6]]}}}