A Prospective Study of Catheter-Related Complications of Intrathecal Drug Delivery Systems

Abstract

Intrathecal drug administration via implanted pump is an effective treatment for intractable pain and spasticity but can be compromised by catheter-related complications. To determine the etiology of catheter-related complications, we have conducted a multicenter, prospective study of the long-term performance of a one-piece catheter system. Data pertaining to catheter-related complications were collected at implant and at specified times during the follow-up period. Catheter implantation characteristics that might affect complications were assessed. Two hundred nine patients were studied at 22 participating centers, with 1764 cumulative patient-months of catheter experience. Forty-nine catheter system complications occurred in 37 patients (7 complications related to the catheter itself, and 42 complications related to the implantation procedure). The 9-month complication-free "survival" rate was 78.9% overall (95.5% for the catheter itself). No specific catheter implantation characteristics were associated with the occurrence of complications. These data indicate that the incidence of complications for a one-piece catheter system is similar to that of commercially available two-piece systems, and highlight the need for careful surgical technique during implantation.

Microfracture of a Baclofen Pump Catheter with Intermittent Under- and Overdose

“…The commonest cause of catheter malfunction in more recent studies would appear to be the implantation procedure [6], characterized by malfunction within 6 months of operation. However this particular patient presented 2 years later.…”

“…It has recently been increasingly employed in the management of pediatric patients. Whilst serious complications are rare, the commonest cause of malfunction remains the intrathecal catheter [6]. This article presents the first reported case of malfunction due to a microfracture that was not detected using conventional imaging.…”

Migrating lumbar intrathecal catheter fragment associated with intracranial subarachnoid hemorrhage

“…5 In a prospective study involving 209 patients undergoing implantation of lumbar intrathecal catheter drug delivery systems for pain or spasticity, 7 (3.3%) catheter-related complications were reported. 6 Three patients (1.4%) had leakage, cuts, or breaks in the catheter, and only 2 patients (0.9%) had catheter dislodgement or migration. 6 Numerous cases of migration of lumbar intrathecal catheters to unusual locations have been reported, including migration to the spinal cord, 1 the neural foramen, 10 and most significantly, the intracranial space.…”

Intrathecal Baclofen Toxicity and Deep Coma in Minutes

“…In addition, infections, wound dehiscence, seroma, cerebrospinal fluid leak, and mechanical problems related to the pump and catheter can occur, which can cause life-threatening complications (6), as seen in our patient. However, pump-related complications (ie, mechanical device failures) are said to be rare in currently available systems (7).…”