Paraspinal subfascial placement of lumbar intrathecal baclofen catheters: short-term outcomes of a novel technique.
OBJECTIVE
Techniques for the placement of intrathecal baclofen (ITB) systems have been described in detail, with special consideration given to complications from hardware placement. Risks including catheter kinking and migration, hardware erosion through the skin, and lumbar CSF leak are elevated given the often-low body mass index and poor nutritional status of this patient population. The bulk of a spinal catheter and fascial connector within the lumbar wound may increase the potential for the aforementioned risks, leading to potential risks for wound infection and breakdown. The authors' experience has led them to develop a novel method of paraspinal subfascial lumbar catheter placement to address these risks. The authors describe a novel lumbar intrathecal catheter placement technique as part of the ITB system.


METHODS
All patients undergoing placement of an ITB system by the senior author at New York University Langone Medical Center between July 2010 and March 2011 underwent paraspinal subfascial lumbar catheter placement. Patients were followed-up by the surgeon 2 weeks after implantation and followed up and managed by their physiatrist thereafter, for an average of 5 months (range 0.5-9 months). Results Of the 20 patients who underwent this method of intrathecal catheter placement, none developed any hardware erosion, catheter migration, or CSF leak. One patient developed an abdominal wound infection 3 weeks after implantation, necessitating pump removal.


CONCLUSIONS
In this initial short-term experience, subfascial placement of the lumbar spine intrathecal catheter may be an improvement over the traditional method of catheter placement. There is reduced risk of catheter migration or kinking, hardware erosion, CSF leak, and decreased operative time, all yielding a decreased reoperation rate in this vulnerable population.
Department of Neurosurgery, New York University Langone Medical Center, New York, New York, USA. luigi.bassani@nyumc.org
Luigi
L
Bassani
David H
DH
Harter
D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage*; D002408:Catheters, Indwelling; D002547:Cerebral Palsy / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004421:Dystonia / Q000188:drug therapy* / Q000209:etiology; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002534:Hypoxia, Brain / Q000188:drug therapy; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D007647:Kernicterus / Q000188:drug therapy; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D015518:Rett Syndrome / Q000188:drug therapy; D055815:Young Adult
D009125:Muscle Relaxants, Central; D001418:Baclofen