Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD

Current Issue - May 2022 - Vol 6 Issue 3 Index  |  Previous  |  Next



  1. 2022;3;115-118 Intrathecal Catheter Puncturing Followed by a Pocket Fill After a Pump Refill: A Case Report and Review of the Literature
    Case Report
    Andrea Tinnirello, MD, and Carola Santi, MD.

BACKGROUND: Refilling intrathecal drug delivery systems is a delicate procedure that can lead to serious complications. We report the first case of catheter damage during a refill.

CASE REPORT: A patient implanted with a 20-mL reservoir pump for intrathecal baclofen infusion for severe spasticity complained of spasticity increase after a complex refill. Despite increasing the drug dosage, the patient’s symptoms did not improve, and, after another refill, he was hospitalized for deep sedation and unresponsiveness.
Surgical revision demonstrated a catheter lesion close to the connection with the pump reservoir.
We hypothesize that the catheter had been lesioned during the first refill and, after the last refill, a pocket fill occurred with a significant dose of baclofen reaching the intrathecal space.

CONCLUSION: Ultrasound or fluoroscopic guidance should be used when performing challenging pump refills to avoid potentially catastrophic adverse events such as catheter lesions or pocket fills.

KEY WORDS: Baclofen, case report, catheter, intrathecal therapy, pocket fill, spasticity