Persistent Spinal Headache After Removal of Intrathecal Drug Delivery System: A Case Report and Review of Literature

Kurnutala, Lakshmi N; Kim, David; Sayeed, Huma; Sibai, Nabil

doi:10.5812/aapm.29786

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…Kurnutala et al [10] reported on a transcutaneous CSF leakage case with persistent spinal headache after removal of IDDS that was successfully managed with a surgical dura repair. Their patient had a postural headache with CSF leak-…”

Section: Discussionmentioning

confidence: 99%

Suspected transcutaneous cerebral spinal fluid leakage without postural headache after implantable intrathecal drug delivery system removal - A case report -

et al. 2019

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An implantable intrathecal drug delivery system (IDDS) could be used for various malignant or non-malignant chronic pain [1]. Even though the IDDS insertion is an invasive procedure that makes a direct conduit into the central nervous system for analgesics delivery, the use of IDDS is increasingly popular because it is very effective in treating chronic intractable pain and is supported by multiple studies [2,3]. We report on the case of a patient who had a clear discharge from a suspected cerebral spinal fluid (CSF) leakage through a lumbar wound after intrathecal morphine pump removal surgery. It was an uncertain case of CSF leakage because the patient did not suffer from a headache. Finally, the clear discharge was successfully resolved by a single epidural blood patch. CASE REPORTA 55 year-old man had a post herpetic neuralgia (PHN) affecting the right shoulder and arm for 10 years. He experienced piercing, severe burning pain (visual analogue scale[VAS] 8/10) that was not easily managed by various medications such as oxycodone, morphine, fentanyl transdermal patch, milnacipran, and pregabalin. Pain interventions such as stellate ganglion block, cervical epidural block, and brachial plexus block were performed multiple times. Those procedures only relieved his pain for a few brief moments.Eight years ago, a spinal cord stimulator was implanted on his cervical spinal cord area though it did not successfully relieve the pain (Fig. 1). An intrathecal morphine pump insertion was performed to control the intractable PHN. Other physical examination and laboratory results was unremarkable. His coagulation profiles were within the normal ranges.In the intrathecal morphine trial, his right arm pain was reduced to VAS 5/10 with the injection of 0.3 mg morphine sulfate into the L3-4 interspinous space. A permanent morphine pump was implanted two days later.

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Section: Discussionmentioning

confidence: 99%

Suspected transcutaneous cerebral spinal fluid leakage without postural headache after implantable intrathecal drug delivery system removal - A case report -

et al. 2019

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“…However, complications following IDDS catheters removal are scarce in the literature. Most reports describe complications related to retained catheters, catheter migration, or CSF leak after IDDS explant .…”

Section: Discussionmentioning

confidence: 99%

“…A lumbar drain was inserted in one patient and the other had the incision reclosed. Kurnutalla et al described a patient with an external leak following an infection after IDDS explant. Their patient had a laminectomy and direct dural closure with suture.…”

Section: Discussionmentioning

confidence: 99%

Removal of Intrathecal Catheters Used in Drug Delivery Systems

Frizon

Sabharwal

Maiti

et al. 2018

Neuromodulation: Technology at the Neural Interface

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“…Kinking of the catheter and migration of the pump are recognized risk factors for catheter occlusion with previous generation of catheters ( 4 , 5 , 7 - 10 ). Other adverse effects associated with intrathecal drug delivery include spinal headache, as reported by Kurnutala et al in 2015 ( 11 ). The twisting and occlusion of the catheter in ITB systems can also be described as Twidder’s syndrome; first coined in 1968, Twiddler’s syndrome described the malfunction of a pacemaker secondary to manipulation of the pulse generator by the patient ( 12 ).…”

Section: Introductionmentioning

confidence: 90%

Occlusion of the Ascenda Catheter in a Patient with Pump Twiddler’s Sydrome: A Case Report

et al. 2018

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IntroductionIntrathecal baclofen (ITB) therapy is an effective way to manage spasticity in numerous conditions, including multiple sclerosis, stroke, and cerebral palsy. While pump failure is a common complication of ITB, improvements in device design have led to reduction of complications. In particular, the Ascenda catheter from Medtronic, Inc. was designed to resist kinking and associated complications; indeed, no incidences of catheter twisting or occlusion have been reported in literature prior to this case.Case ReportWe report a case of a 32-year old gentleman who presented to the clinic with symptoms of baclofen withdrawal 19 months after he had a programmable pump implanted for spasticity. During the diagnostic evaluation it was discovered that the patients pump had flipped in his abdominal pocket. He was taken to surgery to reorient the pump, during which time it was noted the catheter was tightly coiled on itself occluding flow. The twisted catheter was excised and replaced with a new segment.His symptoms subsequently resolved.ConclusionsAlthough catheter occlusions have subsided since the approval of the Ascenda catheter, pump twiddler’s syndrome remains a risk factor for this complication. This is the first report describing this syndrome in a patient with the Ascenda catheter.

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Persistent Spinal Headache After Removal of Intrathecal Drug Delivery System: A Case Report and Review of Literature

Cited by 5 publications

References 13 publications

Suspected transcutaneous cerebral spinal fluid leakage without postural headache after implantable intrathecal drug delivery system removal - A case report -

Suspected transcutaneous cerebral spinal fluid leakage without postural headache after implantable intrathecal drug delivery system removal - A case report -

Removal of Intrathecal Catheters Used in Drug Delivery Systems

Occlusion of the Ascenda Catheter in a Patient with Pump Twiddler’s Sydrome: A Case Report

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