BACKGROUND: Intrathecal drug delivery systems (IDDS) offer targeted pain relief with lower drug doses but come with risks. Our report describes a unilateral L5 neuropathy following an uncomplicated IDDS implant.

CASE REPORT: A 45-year-old man with chronic back pain and prior L4-L5 laminectomy presented with severe pain after a fall. Imaging was unremarkable, and he was deemed a candidate for IDDS implantation. The procedure, which included catheter placement to the T6-T7 level and morphine pump insertion, was initially well tolerated without immediate complications. On postoperative day one, he developed right foot weakness and numbness. Magnetic resonance imaging showed no mechanical etiologies, and conservative management was recommended. By postoperative day 10, his symptoms had completely resolved.

CONCLUSIONS: Our case highlights the importance of early recognition of IDDS complications for effective management and prevention.

KEYWORDS: L5 neuropathy, Unilateral neuropathy, case report, intrathecal pump, postoperative