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ISRN Neurology
Volume 2012 (2012), Article ID 575168, 6 pages
http://dx.doi.org/10.5402/2012/575168
Research Article

Complications of Intrathecal Baclofen Pump: Prevention and Cure

1Pediatric Neurology and Movement Disorder Program, Oakwood Health System, Dearborn, MI, USA
2Department of Pediatric Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh 11393, Saudi Arabia
3Department of Neurosurgery, Henry Ford Health Systems, Detroit, MI, USA
4Operating Room Services, Oakwood Health System, Dearborn, MI, USA

Received 26 December 2011; Accepted 16 January 2012

Academic Editor: Y. Ersahin

Copyright © 2012 Yasser Awaad et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.