Abstrakt
Background: Intrathecal baclofen (ITB) delivered by programmable pump devices represents an important modality for long-term treatment of severe spasticity when resistance to oral drugs and/or their severe side effects may occur. Despite generally favorable outcomes and relative safety of this method, complications associated with ITB can be observed.
The most common problems include surgery-related complications resulting from system implantation, including catheter failure. Pump rotation is a rare complication with incidence less than 0.3%.
Case report: Seventy-four-years-old female suffered from spasticity after chronic spinal cord injury at T9 level. She underwent successful implantation of ITB pump (Medtronic, Synchromed II) with prompt spasticity relief on baclofen dose of 100 mu g/day.
During the first outpatient appointment, it was difficult to puncture and fill the reservoir with baclofen. Plain x-ray revealed rotation of the pump with reservoir in downright position.
On the same day, the patient underwent emergency surgical revision with correction of the pump position and refill of the reservoir. No baclofen withdrawal syndrome or other complications occurred and the patient recovered well.
Conclusion: Pump rotation is a very unusual and rare complication of ITB treatment. Its prompt management in specialized centers can prevent an urgent situation such as acute withdrawal syndrome after sudden interruption of baclofen delivery.