Kaohsiung Journal of Medical Sciences
Volume 24, Issue 9 , Pages 492-497, September 2008

Catheter Migration After Implantationan Intrathecal Baclofen Infusion Pump for Severe Spasticity: A Case Report

  • Tung-Chou Li

      Affiliations

    • Department of Rehabilitation, Cathay General Hospital, Taipei, Taiwan
    • ,
  • Mei-Hsiu Chen

      Affiliations

    • Department of Internal Medicine, Far Eastern Memorial Hospital, Banqiao, Taiwan
    • ,
  • Jing-Shan Huang

      Affiliations

    • Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
    • ,
  • Jun-Yeen Chan

      Affiliations

    • Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
    • ,
  • Yaun-Kai Liu

      Affiliations

    • Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
    • ,
  • Ming-Hong Chen

      Affiliations

    • Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
    • Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Ming-Hong Chen, Institute of Biomedical Engineering, National Yang-Ming University, 155, Section 2, Linong Street, Beitou, Taipei 112, Taiwan

Received 28 November 2007; accepted 18 April 2008.

Article Outline

We report a case of intrathecal baclofen infusion pump implantation complicated by migration of the catheter tip. A 55-year-old man required an intrathecal baclofen infusion for severe spasticity 4 years after a cervical spinal cord injury with incomplete tetraparesis. Twelve months after initial implantation of the device, the patient began to experience a recurrence of trunk tightness and spasticity. Subsequent X-ray and computed tomography evaluations of the catheter system revealed pooling of contrast medium outside of the intrathecal distribution in the lumbar subcutaneous region of the back and therefore migration of the pump catheter tip. At surgical revision, emphasis was placed on minimizing the length of catheter outside of the spine and securing the catheter in the supraspinous fascia with a right-angled anchor. The distance between the anchors and the entry point of the catheter into the supraspinous fascia was also reduced to prevent slipping when the patient bends forward. After surgery, the patient's spasticity improved and, 1 year later, he has experienced no further complications during follow-up, requiring an average baclofen dose of 150 mg/day. Here, we describe several surgical methods intended to secure the intrathecal catheter and prevent catheter migration. Other complications related to catheter failure are also highlighted.

Key Words:  baclofen , infusion pump , intrathecal , spasticity , spinal cord injury , baclofen withdrawal syndrome

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References 

  1. Feldman RG , Kelly-Hayes M , Conomy JP , et al.   Baclofen for spasticity in multiple sclerosis. Double-blind crossover and three-year study . Neurology . 1978;28:1094–1098
  2. Young RR , Delwaide PJ . Drug therapy: spasticity (second of two parts) . N Engl J Med . 1981;304:96–99
  3. Corston RN , Johnson F , Godwin-Austen RB . The assessment of drug treatment of spastic gait . J Neurol Neurosurg Psychiatry . 1981;44:1035–1039
  4. Frost F , Nanninga J , Penn R , et al.   Intrathecal baclofen infusion. Effect on bladder management programs in patients with myelopathy . Am J Phys Med Rehabil . 1989;68:112–115
  5. Latash ML , Penn RD , Corcos DM , et al.   Effects of intrathecal baclofen on voluntary motor control in spastic paresis . J Neurosurg . 1990;72:388–392
  6. Latash ML , Penn RD , Corcos DM , et al.   Short-term effects of intrathecal baclofen in spasticity . Exp Neurol . 1989;103:165–172
  7. Lazorthes Y , Sallerin-Caute B , Verdie JC , et al.   Chronic intrathecal baclofen administration for control of severe spasticity . J Neurosurg . 1990;72:393–402
  8. Loubser PG , Narayan RK , Sandin KJ , et al.   Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury . Paraplegia . 1991;29:48–64
  9. Ochs G , Struppler A , Meyerson BA , et al.   Intrathecal baclofen for long-term treatment of spasticity: a multicentre study . J Neurol Neurosurg Psychiatry . 1989;52:933–939
  10. Parke B , Penn RD , Savoy SM , et al.   Functional outcome after delivery of intrathecal baclofen . Arch Phys Med Rehabil . 1989;70:30–32
  11. Penn RD , Kroin JS . Continuous intrathecal baclofen for severe spasticity . Lancet . 1985;2:125–127
  12. Penn RD , Kroin JS . Long-term intrathecal baclofen infusion for treatment of spasticity . J Neurosurg . 1987;66:181–185
  13. Penn RD , York MM , Paice JA . Catheter systems for intrathecal drug delivery . J Neurosurg . 1995;83:215–217
  14. Coffey JR , Cahill D , Steers W , et al.   Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study . J Neurosurg . 1993;78:226–232
  15. Penn RD . Intrathecal baclofen for spasticity of spinal origin: seven years of experience . J Neurosurg . 1992;77:236–240
  16. Albright AL , Gilmartin R , Swift D , et al.   Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin . J Neurosurg . 2003;98:291–295
  17. Tutak U , Doleys DM . Intrathecal infusion systems for treatment of chronic low back and leg pain of noncancer origin . South Med J . 1996;89:295–300
  18. Ross DA , Byers C , Hall T . A novel approach to prevent repeated catheter migration in a patient with a baclofen pump: a case report . Arch Phys Med Rehabil . 2005;86:1060–1061
  19. Pasquier Y , Cahana A , Schnider A . Subdural catheter migration may lead to baclofen pump dysfunction . Spinal Cord . 2003;41:700–702

PII: S1607-551X(09)70007-5

doi:10.1016/S1607-551X(09)70007-5

Kaohsiung Journal of Medical Sciences
Volume 24, Issue 9 , Pages 492-497, September 2008

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