title: Increased spasticity from a fracture in the baclofen catheter caused by Charcot spine: case report.
abstract: In patients with Charcot spine, a loss of normal feedback response from the insensate spine results in spinal neuropathy. Increasing deformity, which can manifest as sitting imbalance, crepitus, or increased back pain, can result. We present the case of a patient with a high-thoracic spinal cord injury (SCI) who subsequently developed a Charcot joint at the T10-11 level that resulted in a dramatic increase in previously controlled spasticity after fracture of an existing baclofen catheter. The 68-year-old man with T4 paraplegia presented with increasing baclofen requirements and radiographic evidence of fracture of the intrathecal baclofen catheter with an associated Charcot joint with extensive bony destruction. The neuropathic spinal arthropathy caused mechanical baclofen catheter malfunction and resulting increased spasticity. The patient was found to have transected both his spinal cord and the baclofen catheter. Treatment consisted of removal of the catheter and stabilization with long-segment instrumentation and fusion from T6 to L2. Follow-up radiographs obtained a year and a half after surgery showed no evidence of hardware failure or significant malalignment. The patient has experienced resolution of symptoms and does not require oral or intrathecal baclofen. This is the only reported case of a Charcot spine causing intrathecal catheter fracture, leading to increased spasticity. This noteworthy case suggests that late spinal instability should be considered in the setting of SCI and increased spasticity.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Ravindra
authors.affiliation: Department of Neurosurgery, Washington University, St. Louis, MO.
authors.forename: Wilson Z
authors.initials: WZ
authors.lastname: Ray
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Sayama
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah. Electronic address: Andrew.Dailey@hsc.utah.edu.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Dailey
mesh_terms: D000368:Aged; D001177:Arthropathy, Neurogenic / Q000150:complications* / Q000209:etiology; D001418:Baclofen / Q000008:administration & dosage; D002404:Catheterization / Q000009:adverse effects*; D004868:Equipment Failure; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009128:Muscle Spasticity / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000150:complications; D013904:Thoracic Vertebrae
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: Arthropathy, neurogenic; Baclofen; Case reports; Catheters; Muscle spasticity; Rehabilitation; Spinal cord injuries