Pumps and Catheters

KEY FACTS

Terminology

• Intrathecal baclofen (ITB)

• Intraspinal drug delivery (IDD)

• Malfunction or malposition of pump or catheter delivery system

Pathology

• ITB used for treatment of spasticity

  • Typically used in children with severe quadriplegic pattern cerebral palsy

• IDD system therapy widely utilized in patients with intractable, nonmalignant, and malignant pain

  • Epidural analgesia trial may be conducted to document efficacy prior to implantation of permanent intrathecal drug delivery pump

Clinical Issues

• ITB rate of complications varies widely, range: 8-30%

  • Baclofen complications relate to withdrawal and overdose

  • Infection rates: 8-10%

  • Hardware- related complications from 5-20%

  • Majority of complications requiring reoperation involve the catheter

• IDD systems

  • Granuloma formation at catheter tip relatively common

  • Effects include loss of analgesia or new/progressive neurologic symptoms

Diagnostic Checklist

• Malfunction must be evaluated from pump level to distal aspect of catheter

  • CT abdomen following baclofen side port contrast injection extending cephalad beyond intradural catheter tip

TERMINOLOGY