Position-Dependent Intrathecal Baclofen System Catheter Failure Resulting in Debilitating Spasticity: A Case Report

Cureus, 2024 · DOI: 10.7759/cureus.53425 · Published: February 1, 2024

Simple Explanation

An intrathecal baclofen (ITB) pump delivers baclofen directly to the spinal cord to alleviate severe spasticity and pain. While effective, complications can arise, such as catheter failure, leading to a resurgence of symptoms and withdrawal issues. This case report describes a patient who experienced transient catheter occlusion due to its placement near the vertebrae, which was worsened by certain body positions. This led to inconsistent baclofen delivery and recurring spasticity. Surgical revision focused on repositioning and anchoring the catheter away from bony prominences to prevent future occlusions. Following the revision, the patient's spasticity was better controlled, and baclofen withdrawal symptoms were resolved.

Study Duration

Not specified

Participants

A 24-year-old male with a history of chronic C5 incomplete quadriplegia

Evidence Level

Case Report

Key Findings

1
The initial catheter anchoring occurred directly adjacent to the vertebrae, leading to a position-dependent catheter occlusion.
2
Transient catheter occlusion can lead to intrathecal baclofen withdrawal symptoms secondary to postural changes.
3
Anchoring the catheter to the supraspinous fascia, away from bony prominences or post-laminectomy sites, can prevent recurrences of catheter occlusion.

Research Summary

This case report highlights a rare instance of position-dependent intrathecal baclofen catheter failure, leading to debilitating spasticity and withdrawal symptoms in a young quadriplegic male. The study emphasizes the importance of proper catheter placement and anchoring techniques during ITB pump implantation to avoid mechanical complications like kinking or compression, especially in patients with spinal cord injuries or post-laminectomy. The successful surgical revision, which involved replacing the ITB pump and catheter with careful attention to anatomical considerations, underscores the need for clinicians to consider mechanical causes when patients report fluctuating spasticity and withdrawal symptoms despite pump adjustments.

Practical Implications

Surgical Technique

Emphasize anchoring the catheter to the supraspinous fascia, away from bony prominences, and minimizing catheter length outside the spine to prevent kinking.

Diagnostic Awareness

Consider positional factors when evaluating patients with ITB pumps who experience fluctuating spasticity or withdrawal symptoms, even if initial imaging studies are normal.

Patient Selection

Recognize that patients with spinal cord injuries or those who have undergone laminectomies may be at higher risk for catheter-related complications and require closer monitoring.

Study Limitations

1
Single case report limits generalizability.
2
Lack of documentation from the initial catheter revision makes it difficult to fully understand the reasons for the initial laminectomy.
3
The exact mechanism of catheter occlusion was inferred intraoperatively but not directly visualized with imaging in the position that caused the problem.

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