Subdural catheter migration may lead to baclofen pump dysfunction

Abstract

Objectives: To report an unusual cause of intrathecal drug delivery failure in baclofen pump device. Study design: A case report of an SCI patient treated with intrathecal baclofen, presenting a drug withdrawal. Setting: Regional spinal cord injuries centre in Geneva (Switzerland). Methods: We present a case of a 38-year-old male with complete T9 spastic paraplegia for 15 years, treated with intrathecal baclofen for 11 years. He recently presented to our centre with a spastic hypertonic episode, associated with rhabdomyolysis. Results: Standard investigations were unrevealing. However, a CT scan performed after injecting a radio-opaque solution by the side port of the pump, showed an unexpected catheter migration into the subdural space. Surgical revision reversed withdrawal symptoms. Conclusions: Subdural catheter migration must be considered in the differential diagnosis of intrathecal drug delivery system failures. We recommend the use of the CT scan after contrast injection, to detect the localization of the distal catheter tip and confirm the normal diffusion into the subarachnoid space.

Intrathecal drug therapy using the Codman Model 3000 Constant Flow Implantable Infusion Pumps: experience with 17 cases

“…The complications that were experienced are similar to other implantable infusion devices, 13,18,19,[22][23][24][25] with the exception that there were no failures of the Codman pump mechanism, unlike reports of failures in the programmable pumps. 19,24 Five of the patients had programmable pumps previously and chose to have them replaced with an Codman Constant Flow pump when the programmable pump batteries expired.…”

Review: Procedure- and Device-Related Complications of Intrathecal Baclofen Administration for Management of Adult Muscle Hypertonia: A Review

“…Four studies encompass more than 100 pump implants, 3,12-14 10 studies between 40 and 80 implants, 7,15-23 13 studies between 10 and 35 implants, 4,24-35 and 5 studies fewer than 10 implants, 36-40 with 10 case reports comprising 14 implants in total. [41][42][43][44][45][46][47][48][49][50] Some participants described in the reports did …”

Bilateral Subdural Hematoma Following Implantation of Intrathecal Drug Delivery Device

“…Children appear to be at higher risk for complications than adults (10). Exceptional complications have been reported: migration of the catheter into the subdural space (11) and development of epidural lipomatosis requiring laminectomy (12).…”