title: Complications of intrathecal baclofen pump: prevention and cure.
abstract: Increasingly, spasticity is managed with surgically implanted Intrathecal Baclofen pumps. Intrathecal Baclofen pump revision surgery unrelated to programmable pump end-of-life is not uncommon, requiring special attention during pre-, intra-, and postoperative management. We aimed to identify and describe complications of Intrathecal Baclofen pump as well as to report avoidance and management of complications. Methods and Materials. Through 2002-2006, at the department of neurosurgery, Henry Ford and Oakwood Health Systems, Intrathecal Baclofen pumps were implanted in 44 patients: 24 children versus 20 adults; 30 "primary-implant-patients"; 14 "revision-only patients". We evaluated reasons for revision surgeries and diagnostic workup requirements. Results. Eight primary-implant-patients required 14 revisions and 7 of revision-only patients needed 13 procedures. Seven patients with slowly increasing baclofen-resistant spasticity had either (i) unsuspected pump-catheter connector defects, (ii) an X-ray-documented pump-catheter connector defect, (iii) X-ray-demonstrated fractured catheter with intrathecal fragment. Implant infections occurred in 4 cases. Scintigraphy revealed occult CSF leakage N=1 and intrinsic pump failure N=1. Conclusion. Intrathecal Baclofen pumps, although very gratifying, have a high, technique-related complication incidence during implant life. Meticulous technique, high clinical suspicion, appropriate workup, and timely surgical management can reduce surgical complications of Intrathecal Baclofen pump implantation.
authors.affiliation: Pediatric Neurology and Movement Disorder Program, Oakwood Health System, Dearborn, MI, USA.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Awaad
authors.forename: Tamer
authors.initials: T
authors.lastname: Rizk
authors.forename: Iram
authors.initials: I
authors.lastname: Siddiqui
authors.forename: Norbert
authors.initials: N
authors.lastname: Roosen
authors.forename: Kelly
authors.initials: K
authors.lastname: McIntosh
authors.forename: G Michael
authors.initials: GM
authors.lastname: Waines