Incidence and Identification of Intrathecal Baclofen Catheter Malfunction

Dvorak, Eric M.; McGuire, John R.; Nelson, Mary Elizabeth S.

doi:10.1016/j.pmrj.2010.01.016

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Volume 2, Issue 8 , Pages 751-756, August 2010

Incidence and Identification of Intrathecal Baclofen Catheter Malfunction

This information was presented as a poster presentation at the APM&R Annual Assembly in Austin, Texas, in 2009.

Received 22 November 2009; accepted 28 January 2010. published online 05 July 2010.

Objective

A retrospective chart review was undertaken of cases of intrathecal baclofen (ITB) pump/catheter malfunction and the diagnostic tests performed to identify the problem. An internal review was performed to develop a diagnostic flow chart to have a systematic method for identifying ITB pump and catheter complications.

Design

Retrospective chart review.

Setting

Tertiary care hospital.

Participants

A total of 167 adult patients currently followed in outpatient clinic with intractable spasticity and ITB pump implanted between January 1994 and May 2009.

Interventions

None.

Main Outcome Measures

Catheter malfunction was identified either by anterior/posterior and lateral thoracic/lumbar radiographs, fluoroscopic guided side port access, contrast agent injection followed by CT (fluoro/CT) scan, or indium radionuclide studies.

Results

During the study period, 33 patients had 37 catheter revisions. Radiographs were obtained in all cases; fluoro/CT studies in 22, and indium studies in 6. Four cases had both fluoro/CT and indium studies. A total of 13 cases (35.1%) were diagnosed with radiographs; 9 cases (24.3%) were diagnosed by inability to withdraw cerebral spinal fluid from the side port; 13 cases (35.1%) were diagnosed with fluoro/CT studies; and 2 cases (5.4%) were diagnosed with indium studies. Fluoro/CT studies demonstrated subdural catheter location in 7 cases. A total of 2 of 4 cases with both fluoro/CT and indium studies had normal-appearing indium scans and an abnormal fluoro/CT study confirming subdural catheter placement.

Conclusions

On the basis of an internal review of the diagnostic studies used to identify patients with suspected ITB pump/catheter malfunction, a troubleshooting flow chart was developed. Timely identification and correction of potential ITB complications could improve the clinical effectiveness of ITB and may reduce unnecessary health-care costs.