ICNC Abstracts, ICNC 2018

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Prevention and Cure of the Intrathecal Baclofen Pump .
Yasser Awaad

Last modified: 2018-09-09


Increasingly, spasticity is managed with surgically implanted ITB pumps. ITB revision surgery unrelated to programmable pump end-of-life is not uncommon, requiring special attention during pre-, intra-, and post-operative management. We aim to identify and observe complications of ITB (Intrathecal Baclofen) pump as well as to report avoidance and cure of complications.

Methods and Materials: Through 2002-2006, we implanted ITB pumps in 44 patients; 24 children versus 20 adults; 30 «primary-implant-patients»; 14 «revision-only patients». We evaluated reasons for revision surgeries and diagnostic work-up requirements.

Results: Eight out of 30 «primary-implant-patients» required 14 revisions and 7 of 11 «revision-only-patients» needed 13 procedures. Seven patients with slowly increasing baclofen-resistant spasticity had either:

1) Unsuspected pump-catheter connector defects [N=4] with a subcutaneously dislocated IT (intrathecal) catheter [N=1],

2)  An X-ray-documented pump-catheter connector defect [N=1]

3) X-ray-demonstrated fractured catheter with intrathecal (IT) fragment [N=2] requiring laminectomy [N=1]. Injection studies revealed IT peri-catheter arachnoiditis [N=1; managed without laminectomy], and connector-related dye leakage [N=3]. Implant infections occurred in 4 cases [3 were pre-operated]. Scintigraphy revealed occult CSF leakage [N=1]. Intrinsic pump failure [N=1].

Conclusions: ITB, although very gratifying, has a high, technique-related complication incidence during implant life. Meticulous technique, high clinical suspicion, appropriate work-up, and timely surgical management can reduce surgical ITB complications.



Baclofen; Intrathecal pump; Complications

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