title: The role of surgical placement and pump orientation in intrathecal pump system failure: a technical report.
abstract: Intrathecal pump catheter complications are the most common cause of failure in drug delivery. A previous report has documented that intra-abdominal positioning of the intrathecal pump may predispose the pump-catheter neck to premature catheter breakdown and leakage. Based on this report, we reviewed over 100 intrathecal pump cases to determine the frequency of malpositioning and its role in the pathogenesis of catheter failure. We found three specific cases where a 'fulcrum effect' occurred due to intra-abdominal positioning of the pump predisposing the catheter to breakdown. This study demonstrates that intra-abdominal placement of the pump can predispose the catheter to failure/breakdown and that surgeons should attempt to place the pump catheter neck in a superiomedial position, distant from any bony prominences, to prevent the 'fulcrum effect' on the pump-catheter neck junction and reducing the likelihood of either internal or external compressive forces.
authors.affiliation: Department of Surgery, Division of Neurosurgery, North Shore University-Long Island Jewish Health System, New Hyde Park, NY 11004, USA. drrdd@yahoo.com
authors.forename: Rob D
authors.initials: RD
authors.lastname: Dickerman
authors.forename: Q E
authors.initials: QE
authors.lastname: Stevens
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Schneider
mesh_terms: D015360:Analgesia, Epidural / Q000295:instrumentation*; D001418:Baclofen / Q000008:administration & dosage*; D002408:Catheters, Indwelling; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002648:Child; D020878:Device Removal; D019544:Equipment Failure Analysis; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal / Q000295:instrumentation*; D009020:Morphine / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging
chemical_list: D009020:Morphine; D001418:Baclofen