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Intrathecal Catheter (intrathecal + catheter)

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Medical Sciences100%

Selected Abstracts

Catheter Tip Granuloma Associated with Sacral Region Intrathecal Drug Administration

NEUROMODULATION, Issue 4 2003
Fernandez Julius MD
Abstract Spinal cord compression from catheter tip granulomatous masses following intrathecal drug administration may produce devastating permanent neurologic deficits. Some authors have advocated intrathecal catheter placement below the conus medullaris to avoid the possibility of spinal cord involvement. Multiple cases of catheter tip granulomas in the thoracolumbar region have been reported. We present a unique case of a sacral region catheter tip inflammatory mass producing permanent neurologic deficits. A 71-year-old white male with a diagnosis of failed back surgery syndrome was referred to the senior author for evaluation. After more extensive conservative therapy, including spinal cord stimulation, failed to yield adequate pain relief, he was offered implantation of an intrathecal pump for opioid administration. Excellent pain relief was achieved in the postoperative period; however, three years after implantation, he presented with progressive saddle anesthesia and bowel/bladder incontinence. Magnetic resonance imaging demonstrated a space occupying lesion associated with the catheter tip. The patient underwent emergent second level complete sacral laminectomy with partial resection of an intradural extra-axial mass and removal of intrathecal catheter. At discharge, the patient had no restoration of neurologic function. Histologic examination of the mass confirmed a sterile inflammatory mass. It has been suggested that intrathecal catheters be placed below the conus medullaris to avoid the possibility of spinal cord involvement. We present an unusual case documenting devastating permanent neurologic deficits from a catheter tip granuloma in the sacral region. [source]

(634) Reliability and Clinical Utility of an Implanted Intraspinal Catheter Used in the Treatment of Spasticity and Pain

PAIN MEDICINE, Issue 2 2000
Article first published online: 25 DEC 200
Authors: Elliot Krames, Pacific Pain Treatment Center; Iva Chapple, Carolina Pain Center Objectives: To examine the performance and reliability of a redesigned implantable intrathecal catheter. Materials: A total of 212 catheters were implanted in 202 patients in this 22-center, prospective study of an implantable catheter/pump system used to deliver intrathecal drugs for the treatment of pain and spasticity. Along with physician assessments of each use, the rates of common catheter complications (dislodgements, disconnections, fractures, and kinks) experienced during the study were analyzed in relation to implant conditions (catheter entry site, tip position, and anchoring method). Results: A cumulative study of 3112.8 months of patient experience (average: 15.4 months; range: 0 to 30.2 months per catheter) revealed an overall catheter-caused complication rate of 0.3% per patient month. Physician assessments were favorable, with 89% rating this catheter as better than previously used intraspinal catheters. A measure of catheter survival estimates (Kaplan-Meier) at 9 months was 89% including all complications. Comparison of data relating to implant techniques demonstrated a variety of catheter implant techniques (entry, positioning, anchoring) with no correlation between any one technique and the common complications. Conclusions: Performance data and physician assessments indicate that this catheter is an improvement over the previously available catheter. [source]

Catheter Tip Granuloma Associated with Sacral Region Intrathecal Drug Administration

NEUROMODULATION, Issue 4 2003
Fernandez Julius MD
Abstract Spinal cord compression from catheter tip granulomatous masses following intrathecal drug administration may produce devastating permanent neurologic deficits. Some authors have advocated intrathecal catheter placement below the conus medullaris to avoid the possibility of spinal cord involvement. Multiple cases of catheter tip granulomas in the thoracolumbar region have been reported. We present a unique case of a sacral region catheter tip inflammatory mass producing permanent neurologic deficits. A 71-year-old white male with a diagnosis of failed back surgery syndrome was referred to the senior author for evaluation. After more extensive conservative therapy, including spinal cord stimulation, failed to yield adequate pain relief, he was offered implantation of an intrathecal pump for opioid administration. Excellent pain relief was achieved in the postoperative period; however, three years after implantation, he presented with progressive saddle anesthesia and bowel/bladder incontinence. Magnetic resonance imaging demonstrated a space occupying lesion associated with the catheter tip. The patient underwent emergent second level complete sacral laminectomy with partial resection of an intradural extra-axial mass and removal of intrathecal catheter. At discharge, the patient had no restoration of neurologic function. Histologic examination of the mass confirmed a sterile inflammatory mass. It has been suggested that intrathecal catheters be placed below the conus medullaris to avoid the possibility of spinal cord involvement. We present an unusual case documenting devastating permanent neurologic deficits from a catheter tip granuloma in the sacral region. [source]

NS12 THE MANAGEMENT OF SPASTICITY IN THE SPINAL INJURED PATIENT

ANZ JOURNAL OF SURGERY, Issue 2007
R. H. Acland
Spasticity is one of the hallmarks of the upper motor neurone syndrome which occurs following injury to the spinal cord anywhere above the level of the conus medullaris (approx L1). Early effective management of spasticity can prevent a multitude of complications. Persistent spasticity can result in contractures which significantly impair functional independence. There is a long history of the use of various surgical interventions for this complication. Physical therapy is pivotal in the overall management. A variety of pharmacological approaches are commonly used, however efficacy has to be balanced against adverse effects. The botulinum industry has limited benefit but can be useful in focal spasticity. In this presentation I will discuss the use of baclofen delivered via intrathecal catheters connected to sophisticated implanted pumps. In Christchurch we have had a multidisciplinary team providing this service for New Zealand. I will provide the results of our eight years experience in the use of intrathecal baclofen therapy (ITB). Assessment, baclofen pharmacology, surgical technique, efficacy, complications and costs will be discussed. The future challenges will also be highlighted. [source]