Pumps and Catheters



  • Intrathecal baclofen (ITB)

  • Intraspinal drug delivery (IDD)

  • Malfunction or malposition of pump or catheter delivery system


  • 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

This is a syringopleural shunt failure due to formation of a pseudocyst at the catheter site in the chest. Initial T2W MR study after placement of the shunt shows postoperative change with a small epidural fluid collection in the midthoracic spine and syrinx in the upper thoracic cord .

Sagittal T1WI MR in the same patient 1 year later now shows marked expansion of the syrinx throughout the thoracic cord .

AP chest film in the same patient shows a loculated pleural collection at the site of the coiled shunt catheter .

This is a syringopleural shunt failure with expansion of the extensive cord syrinx due to formation of a pseudocyst at the catheter site in the chest. Axial T1 MR in the same patient shows the large thoracic cord syrinx and a large fluid collection in the left chest at the site of catheter placement .


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