Study Design: Case series. Objectives: To evaluate the risk of pump-and catheter-related complications of intrathecal drug delivery systems. Setting: Tertiary care center in Switzerland. Methods:The medical records of all in-and out-patient adults treated at our institution during a 12-year period were reviewed. All patients that had received intrathecal drug therapy via an implanted pump were invited to a structured interview. Results: One hundred patients, representing therapy with 175 implanted pumps and 132 intrathecal catheters over 552 years, participated in the study. During the observation period, 217 surgical procedures (including 100 primary pump implants) and 5863 pump refills were performed. The annual rate for complications requiring surgical measures was 10.5%, with 35% being pump related and 65% being catheter related. The incidence of infections in our patients was 0.7% per year; all infections appeared during the first 3 months after implantation of the first pump. Conclusions: Complication rates of the patients treated in our center, where we have long-term experience with the indication, implantation and continuous care of patients with intrathecal infusion systems, are in the lowest ranges when compared with other published studies. We consider intrathecal testing before implantation, standardized perioperative procedures and consequent long-term care of the patients in a specialized outpatient clinic to be essential factors for the avoidance of complications.