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Li Y, Zhao S, Candiotti K, Su C. Risk Factors Associated with Postoperative Cerebrospinal Fluid Leaks After Intrathecal Drug Delivery System and an External Pump Implantation in Cancer Patients: A Retrospective Study. Pain Ther 2024; 13:637-650. [PMID: 38724744 PMCID: PMC11111433 DOI: 10.1007/s40122-024-00608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/19/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION To determine risk factors associated with postoperative cerebrospinal fluid leaks (CSFLs) after intrathecal drug delivery system (IDDS) and external pump implantation. METHODS The clinical data of 248 patients with advanced cancer who underwent IDDS implantation from January 2021 to December 2022 at the Department of Pain Medicine at the Hunan Cancer Hospital were retrospectively reviewed. Information regarding age, gender, height, weight, body mass index (BMI), tumour type, albumin levels, haemoglobin levels, history of diabetes and pre- and postoperative anti-tumour therapy was collected and analysed. RESULTS Postoperative CSFLs occurred in 7 of 231 patients (3.30%). Statistical analysis indicated that gender, age, height, weight, BMI, tumour type, albumin levels, haemoglobin levels, history of diabetes, pre- and postoperative chemotherapy, pre- and postoperative radiotherapy, preoperative immunotherapy and postoperative targeted therapy were not independent factors for CSFLs. Preoperative targeted therapy [odds ratio (OR): 16.64; 95% confidence interval (CI): 1.42, 195.56; P = 0.01] and postoperative immunotherapy (OR: 13.38; 95% CI: 1.60, 111.65; P = 0.017) were factors associated with an increased postoperative CSFL rate. Of the two locations where CSFLs can occur, the back (puncture site of catheter, n = 4) and the hypochondriac region (location of infusion port implanted, n = 3), back CSFLs occurred earlier than in the hypochondriac region (18.25 ± 6.45 vs 115 ± 62.02 days, P = 0.032). CONCLUSION Based on the data from our study, the timing of preoperative targeted therapy and postoperative immunotherapy should be considered to prevent the occurrence of CSFLs in cancer pain patients who have an IDDS and external pump.
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Affiliation(s)
- Yuan Li
- Department of Anesthesiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan, China
| | - Shuwu Zhao
- Department of Anesthesiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan, China
| | - Keith Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Chen Su
- Department of Anesthesiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan, China.
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Guzman E, Barbari C, Paganoni J, Cohen J, Delgado-Lebron J. Position-Dependent Intrathecal Baclofen System Catheter Failure Resulting in Debilitating Spasticity: A Case Report. Cureus 2024; 16:e53425. [PMID: 38435163 PMCID: PMC10908597 DOI: 10.7759/cureus.53425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
An intrathecal baclofen pump (ITB) can provide significant relief from excessive spasticity and pain that is difficult to control. However, it is not without its drawbacks. We present a case of a young quadriplegic male who underwent ITB pump placement, suffering four years of transient episodes of severe spasticity with withdrawal symptoms. Multiple adjustments were made to his ITB pump dosing without relief. Extensive workup including interrogation of the pump, serial abdominal radiographs, and fluoroscopic catheter dye study revealed no abnormalities. Intraoperatively, it was discovered that the initial catheter anchoring occurred directly adjacent to the vertebrae, leading to a position-dependent catheter occlusion. He underwent the replacement of his ITB pump and catheter. During surgical revision, emphasis was placed on reducing the length of the catheter outside the spine, anchoring to the supraspinous fascia with avoidance of bony prominences or post-laminectomy sites. After surgery, the patient's spasticity improved, and at the eight-month follow-up, he had no complications, resulting in a mean baclofen dose of 300.2 μg/day. This report highlights the potential risk of life-threatening intrathecal baclofen withdrawal secondary to postural changes, providing technical considerations to prevent recurrences. It also raises awareness regarding patients who are more susceptible to transient catheter occlusion after a spinal cord injury.
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Affiliation(s)
- Elvis Guzman
- Physical Medicine and Rehabilitation, Memorial Healthcare System, Hollywood, USA
| | - Cody Barbari
- Physical Medicine and Rehabilitation, Memorial Healthcare System, Hollywood, USA
| | - Joseph Paganoni
- Medical School, American University of the Caribbean School of Medicine, Cupecoy, MAF
| | - Jackson Cohen
- Physical Medicine and Rehabilitation, Memorial Healthcare System, Hollywood, USA
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Kimoto Y, Oshino S, Tani N, Hosomi K, Khoo HM, Fujita Y, Miura S, Iwata T, Emura T, Matsuhashi T, Onoda Y, Ishiuchi T, Yanagisawa T, Hirata M, Kishima H. Characteristics of Changes in Intrathecal Baclofen Dosage over Time due to Causative Disease. Neurol Med Chir (Tokyo) 2023; 63:535-541. [PMID: 37743509 PMCID: PMC10788484 DOI: 10.2176/jns-nmc.2022-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/13/2023] [Indexed: 09/26/2023] Open
Abstract
Intrathecal baclofen (ITB) therapy effectively treats spasticity caused by brain or spinal cord lesions. However, only a few studies compare the course of treatment for different diseases. We investigated the change in daily dose of baclofen per year and its associated adverse events in patients presenting with the three most common etiologies at our institute: hereditary spastic paraplegia, cerebral palsy, and spinal cord injury. The ITB pumps were implanted from July 2007 to August 2019, with a mean follow-up period of 70 months. In patients with hereditary spastic paraplegia, baclofen dosage was reduced after eight years following ITB introduction, and the treatment was terminated in one patient owing to disease progression. In patients with cerebral palsy, the dosage increased gradually, and became constant in the 11th year. Patients with spinal cord injury gradually increased their baclofen dosage throughout the entire observation period. Severity and adverse event rates were higher in patients with cerebral palsy than in others. The degree and progression of spasticity varied depending on the causative disease. Understanding the characteristics and natural history of each disease is important when continuing ITB treatment.
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Affiliation(s)
- Yuki Kimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Satoru Oshino
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Naoki Tani
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Koichi Hosomi
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Hui Ming Khoo
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Yuya Fujita
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Shimpei Miura
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Takamitsu Iwata
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Takuto Emura
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | | | - Yuji Onoda
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Takamasa Ishiuchi
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine
- Institute for Advanced Co-Creation Studies, Osaka University
| | - Masayuki Hirata
- Department of Neurosurgery, Osaka University Graduate School of Medicine
- Department of Neurological Diagnosis and Restoration, Osaka University Graduate School of Medicine
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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4
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Albright AL. Spasticity and movement disorders in cerebral palsy. Childs Nerv Syst 2023; 39:2877-2886. [PMID: 37410128 DOI: 10.1007/s00381-023-06045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE To review the neurosurgical treatments of children with movement disorders associated with cerebral palsy (CP) during the previous decades, up to the present day. METHODS An extensive literature review was undertaken to identify important publications about this subject. My experience treating children with these disorders over the past three decades was included in the individual sections. RESULTS Peripheral neurotomies have been developed for children with focal spasticity. For those with spastic paraparesis, selective lumbar rhizotomies were developed, and for those with spastic quadriparesis, intrathecal baclofen infusions were developed. Both effectively alleviate spasticity in the affected extremities. Generalized dystonia associated with CP has been treated with deep brain stimulation with mild improvement, but treatment with intrathecal baclofen and intraventricular baclofen improve those movements markedly. No effective treatment has been reported for children with athetoid CP. For those with choreiform CP, deep brain stimulation may be effective but intrathecal baclofen does not appear to be. CONCLUSION Treatment of children with movement disorders associated with CP increased slowly in the 1970s and 1980s but accelerated rapidly in the 1990s with the introduction of lumbar dorsal rhizotomies and intrathecal baclofen. In the last 30 years, tens of thousands of children with spasticity and movement disorders associated with CP have been treated by pediatric neurosurgeons, and their care has become an integral component of current pediatric neurosurgical practice.
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Wilson C, Linczer J, Newman S, Weyhenmeyer J, Roper A, Miller J, Lee A. Intrathecal Baclofen and Opioid Therapy: Cerebrospinal Fluid Leak and Infection Incidence, Risk Factors, and Outcomes. World Neurosurg 2023; 171:e456-e463. [PMID: 36528319 DOI: 10.1016/j.wneu.2022.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intrathecal drug therapy treats medically refractory spasticity and pain. cerebrospinal fluid (CSF) leak or infection can limit efficacy and increase morbidity. We aim to evaluate risk factors and outcomes after CSF leaks and infections requiring reoperation. MATERIALS AND METHODS We retrospectively analyzed our 7-year experience of intrathecal baclofen and opioid operations using a protocol designed to limit CSF leakage and infections. Postoperative complication incidence and risk factors for reoperation were compared with published reports. We assessed outcomes after these complications. RESULTS We analyzed 282 intrathecal baclofen (ITB) and intrathecal opioid (ITO) therapy operations (mean 2.27-year follow-up). 21% developed CSF leaks overall with similar incidences in ITB and ITO patients (19% vs. 25%, p0.3). Overall, 5% of patients developed deep infections with similar incidences between ITB and ITO cohorts (6% vs. 4%, p0.6). Tobacco use and age <50 years were significantly associated with CSF leak in ITO operations. Underweight body mass index, immunosuppression, tobacco use, and primary implantation were associated with infection. When CSF leak or infection occurred, patients suffered more perioperative adverse events and had elevated 90-day readmission rate compared with those without these complications. CONCLUSIONS Our 7-year ITB and ITO therapy using the 8781 Ascenda intrathecal catheter highlights a higher reoperation rate for CSF leak and similar infection incidence to reports using traditional catheters. Multiple modifiable risk factors for CSF leak include recent tobacco use among ITO patients. Body mass index optimization and immunosuppressant elimination may reduce reoperation for infection.
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Affiliation(s)
- Christopher Wilson
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John Linczer
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sharlé Newman
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Johnathan Weyhenmeyer
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexandra Roper
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James Miller
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Albert Lee
- Goodman Campbell Brain and Spine, Carmel, Indiana, USA.
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Reining M, Kretzschmar M. Loss of effectiveness with an implanted drug delivery system for intrathecal pain therapy due to corrosion. Pain Pract 2022; 23:459-462. [PMID: 36447424 DOI: 10.1111/papr.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Intrathecal drug delivery is an established invasive treatment option. Most common complication is catheter malfunction, which can lead to overdose or withdrawal. CASE PRESENTATION A 61-year-old female patient underwent an elective replacement of an intrathecal drug delivery pump. The patient complained about a loss of effectiveness over the past 2 years. Intraoperatively, a white mass corresponding to morphine precipitation in the pump pocket was found, which appeared to be due to corrosion at the pump-catheter connection site. CONCLUSIONS Recommendations on how to deal with the decreasing effectiveness of intrathecal drug delivery and on intraoperative catheter handling are provided.
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Affiliation(s)
- Marco Reining
- Department of Pain Medicine and Palliative Care, SRH Wald-Klinikum Gera GmbH, Gera, Germany
| | - Michael Kretzschmar
- Department of Pain Medicine and Palliative Care, SRH Wald-Klinikum Gera GmbH, Gera, Germany.,SRH University of Applied Health Sciences, Gera, Germany
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Wilson C, McVeigh L, Williams A, Acchiardo J, Bradbury J. Efficacy and Safety of Subfascial Epidural Drainage Protocol After Intraoperative Durotomy in Posterior Thoracic and Lumbar Spine Surgery: Reoperation Prevention and Outcomes Among Drained and Undrained Cohorts. Oper Neurosurg (Hagerstown) 2022; 23:200-205. [PMID: 35972082 DOI: 10.1227/ons.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Persistent cerebrospinal fluid (CSF) egress after durotomy in posterior thoracic or lumbar spine surgery may cause devastating complications. Persistent CSF leaks may require reoperation, which confers additional cost and morbidity. OBJECTIVE To evaluate the efficacy of our subfascial epidural drainage protocol in the setting of durotomy to prevent reoperation. METHODS A retrospective cohort study of drained and undrained cohorts was completed to identify factors associated with reoperation for persistent CSF leak-related symptoms. The efficacy and safety of this 7-day subfascial epidural drainage protocol was assessed by comparing reoperation incidence, perioperative complications, rehabilitation necessity, and readmissions. RESULTS In total, 156 patients underwent subfascial epidural drainage, and 14 were not drained. Subfascial drainage for up to 7 days was associated with a significantly lower incidence of reoperation than no drainage (3.3% vs 14%, respectively; P = .03). Perioperative complication incidence was similar between cohorts (12.8% vs 21.4%, respectively; P = .37), and length of stay was unchanged regardless of drainage (median 7 days). Subfascial drainage conferred a nearly 2-fold relative risk reduction in inpatient rehabilitation requirement (RR 0.55) and 3-fold relative risk reduction in 30-day (RR 0.31) and 90-day readmission (RR 0.36). Factors associated with reoperation among drained patients included drainage longer than 7 days, tobacco use, age younger than 50 years, and longer segment operations. Revision spine surgery was associated with reoperation among undrained patients. CONCLUSION When followed after durotomy, our subfascial epidural drainage protocol results in fewer reoperations than in an undrained cohort without prohibitive cost and no added morbidity.
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Affiliation(s)
- Christopher Wilson
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Bonouvrié LA, Lagendijk KE, Beckerman H, Slot KM, van de Pol LA, Buizer AI. Surgical complications of intrathecal baclofen in children: A single centre, 20-year retrospective cohort study. Eur J Paediatr Neurol 2022; 37:94-97. [PMID: 35180559 DOI: 10.1016/j.ejpn.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 08/18/2021] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Complications of intrathecal baclofen treatment (ITB) with an implanted pump can be severe and require surgery. Surgical implantation techniques and catheter materials for continuous ITB treatment have improved over the past years with the aim to reduce complications. OBJECTIVE To assess: 1) the type and rate of complications of ITB that require surgical intervention, 2) which risk factors influence the occurrence of complications, and, specifically, 3) whether complication rate is influenced by type of catheter used. METHODS A retrospective cohort study was conducted including all children (<18 years old) in one university medical center with pump implantation between 2001 and 2017. All complications requiring surgery were recorded. Risk factors for surgical intervention were determined using multiple logistic regression analysis. Catheter related complications between two types of catheters (silicone vs coated) were compared. RESULTS In total, 88 complications of ITB treatment requiring surgery were found in 47 (36.2%) out of 130 children. These included catheter-related complications (55.7% of all complications), infections (21.6%), cerebrospinal fluid leakage (14.8%), and pump-related complications (7.9%). The silicone catheter type, used until 2012, was found to be a significant risk factor for complications (Odds Ratio 3.75; 95% CI: 1.30-10.83). Since the introduction of the coated catheter type, in 2012, the rate of catheter-related complications decreased, from 0.15 to 0.10 complications per pump year. CONCLUSION The rate of surgical complications of intrathecal baclofen in children is high, and most frequently catheter-related. The number of complications decreased since the introduction of a new, coated, catheter in 2012. This study helps to inform children and their caregivers about the risk of possible complications of ITB, and to identify directions for future improvement of ITB care.
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Affiliation(s)
- Laura A Bonouvrié
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands.
| | - Karen E Lagendijk
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands
| | - Heleen Beckerman
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands
| | - K Mariam Slot
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura A van de Pol
- Department of Child Neurology, Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands; Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
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Feller CN, Awad AJ, Nelson MES, Ketchum N, Pahapill PA. Low Rate of Intrathecal Baclofen Pump Catheter-Related Complications: Long-Term Study in Over 100 Adult Patients Associated With Reinforced Catheter. Neuromodulation 2021; 24:1176-1180. [PMID: 33974333 DOI: 10.1111/ner.13412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Intrathecal baclofen (ITB) is a cost-effective therapy for patients with severe spasticity. The most common complications are catheter-related complications (CRCs) including kinking/occlusion, blockage, migration, fracture, disconnection, and CSF leak. Our objective was to determine the CRC rate in a large cohort of adults with newly implanted ITB pump systems with polymer reinforced silicone catheters. MATERIALS AND METHODS This is a retrospective study of a prospectively maintained database consisting of patients who had undergone implantation of ITB pump systems with Ascenda (Medtronic, Minneapolis) catheters from 2013 to 2020. Over this seven-year period, 141 patients underwent ITB pump system implantations; 126 of which had a minimum of one-year follow-up. RESULTS The 126 patients with a minimum of one year follow-up (average 43 month; range 12-89), had an average age of 51 years (63% male). Severe spasticity was due to spinal cord injury (38%), traumatic brain injury (15%), cerebral palsy (13%), multiple sclerosis (11%), stroke (10%), and other (13%). Nine (7.1%) CRCs occurred in 7 (5.6%) patients (median 6 mo. post-implant): 5 intrathecal catheter occlusions (range 3-52 months post-implant), two fractures in one patient (6 months), one disconnection at the catheter pump interface (2 months), and one due to kinking at 84 months No migrations occurred. CONCLUSIONS Reported CRCs have been high for ITB pump systems. Ours is the first large cohort, long-term study of CRCs related to reinforced catheters; additionally, our low CRC rate compares favorably to previously published data. Thus, implantation of reinforced catheters may be associated with a low CRC rate.
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Affiliation(s)
- Christina N Feller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ahmed J Awad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mary Elizabeth S Nelson
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nicholas Ketchum
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peter A Pahapill
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurosurgery, U.S. Department of Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
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Ehsanian R, Koshkin E, Goins AE, Montera MA, Alles S. Pre- and Post-Interventional Changes in Physiological Profiles in a Patient Presenting With Opioid Withdrawal After Intrathecal Drug Delivery System Failure Related to Assumed Catheter Microfracture. Cureus 2021; 13:e14835. [PMID: 34104585 PMCID: PMC8173817 DOI: 10.7759/cureus.14835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The intrathecal drug delivery system (IDDS) is successfully utilized for the treatment of chronic pain conditions; however, they are associated with complications related to human error and system failure. A case report is presented of a patient with opioid withdrawal (OW) secondary to assumed catheter microfracture. Interrogation of the IDDS allowed for the collection of pre- and post-treatment/stabilization cerebrospinal fluid (CSF), which is used to investigate the possible physiological determinants of OW. A 46-year-old female with a history of low back pain after traumatic low back injury status post-IDDS placement for failed back surgery syndrome presented with signs and symptoms concerning for OW. After every other possible explanation was ruled out, it was hypothesized that there may be IDDS catheter microfracture(s), and catheter replacement led to symptom resolution. There were no significant differences in cytokine levels tested in pre-CSF versus post-CSF samples. Whole-cell patch-clamp electrophysiology analysis of human-induced pluripotent stem cell-derived nociceptors after treatment with pre- and post-CSF samples demonstrated modulation of action potential waveform. In patients presenting with acute OW attribution IDDS malfunction, catheter microfracture must be in the differential, and non-conventional interrogation of the IDDS catheter should be considered. The possible differences in pre-CSF and post-CSF may be more complicated than previously postulated, as there were no significant differences in cytokine profiles; however, treatment of in vitro neurons with pre- and post-CSF resulted in differential neuronal excitability, which may account for some of the symptoms of OW.
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Affiliation(s)
- Reza Ehsanian
- Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, USA
| | - Eugene Koshkin
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Aleyah E Goins
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Marena A Montera
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Sascha Alles
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
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11
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Necking E, Levi R, Ertzgaard P. Complications of intrathecal drug delivery therapy (ITDD): A retrospective study of 231 implantations between 1999 and 2014. Clin Neurol Neurosurg 2021; 205:106630. [PMID: 33865215 DOI: 10.1016/j.clineuro.2021.106630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/29/2020] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Determination of types and frequencies of complications related to ITDD therapy, and assessment of possible risk factors for such complications. METHODS Retrospective study (1999-2014) including all ITDD-implantations at one regional center in Sweden. Descriptors comprised: sex; age; medical condition; body weight index; preoperative ASA-grade; presence of indwelling urinary catheters, feeding tubes, and/or daily urinary or anal incontinence; primary or re-implantation; type of pump and catheter; drug delivered; weekday of surgery; surgical procedure time; surgeon; experience of surgeon; surgical theater; and type of antibiotic prophylaxis. All deaths during the study period were assessed as regards possible relation to ITDD. Data were analyzed with SPSS 25, using Chi2 test for correlations between descriptors and complications. RESULTS 231 ITDD pump implantations/re-implantations occurred in 159 patients. Seventy-eight (34%) instances of complications were found: 33 catheter-associated; 6 pump-associated; and 29 infection-associated, where 16 were surgical site infections. A higher infection rate occurred in pump re-implantations, as compared to primary implantations (p = 0.002), and in patients with traumatic spinal cord injury (TSCI) as compared to other diagnoses (p = 0.02). Cloxacillin as antibiotic prophylaxis correlated with a higher infection risk (p = 0.005) relative to other antibiotic prophylaxis. Prolonged surgical procedure time in re-implantations correlated positively with increased catheter-associated complications (p = 0.006). CONCLUSION Complications in ITDD therapy were common, comprising catheter-, infection-, and pump-associated mishaps. A comprehensive system of care needs to be present for managing complications. Future studies may show less complications due to improved protocols and equipment.
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Affiliation(s)
- Erik Necking
- Department of Rehabilitation Medicine, Region Östergötland & Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Richard Levi
- Department of Rehabilitation Medicine, Region Östergötland & Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Per Ertzgaard
- Department of Rehabilitation Medicine, Region Östergötland & Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Blue R, Shah P, Spadola M, Lang SS, Yoo K, Hampton S, Chen HI. Instituting an intrathecal baclofen pump program at an academic institution. PM R 2021; 14:395-402. [PMID: 33543576 DOI: 10.1002/pmrj.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/14/2021] [Accepted: 01/26/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Rachel Blue
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Priyanca Shah
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Spadola
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shih-Shan Lang
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristen Yoo
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Stephen Hampton
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - H Isaac Chen
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Delhaas EM, Huygen FJPM. Complications associated with intrathecal drug delivery systems. BJA Educ 2021; 20:51-57. [PMID: 33456930 DOI: 10.1016/j.bjae.2019.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 02/08/2023] Open
Affiliation(s)
- E M Delhaas
- Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - F J P M Huygen
- Erasmus University Medical Centre, Rotterdam, the Netherlands
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14
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Kinch L, Kohan L. Headaches of Catheters Past: A Case Report of Persistent Cerebrospinal Fluid Accumulation From a Prior Nonfunctioning Intrathecal Drug Delivery Catheter. Neuromodulation 2020; 23:1052-1053. [DOI: 10.1111/ner.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/13/2020] [Accepted: 02/03/2020] [Indexed: 11/30/2022]
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15
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Abraham M, Gold J, Dweck J, Ward M, Gendreau J, Panse N, Holani K, Gupta P, Mammis A. Classifying Device-Related Complications Associated With Intrathecal Baclofen Pumps: A MAUDE Study. World Neurosurg 2020; 139:e652-e657. [PMID: 32339729 DOI: 10.1016/j.wneu.2020.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intrathecal baclofen (ITB) is an effective treatment for spasticity, and therapeutic levels may be optimized using surgically implanted pumps. Though these devices are effective, complications can pose significant challenges to patients, decreasing the therapeutic effect and potentially requiring reoperation. As such, it is critical that complications associated with ITB be effectively characterized. METHODS We queried the Manufacturer and User Facility Device Experience (MAUDE) database for cases reported during the past 3 years documenting adverse events specifically related to ITB pumps. We identified 1935 adverse events that were individually analyzed and categorized by type of complication. RESULTS Out of the 1935 unique adverse events identified from the MAUDE database, 25.7% were device-related complications (n = 497). Of those, 50.3% were catheter-specific (n = 250), 21.3% (n = 106) were pump-specific, and 28.3% (n = 141) were included, more generally, in catheter or device erosion. CONCLUSIONS The MAUDE database may be a useful resource for evaluating ITB pump complications across a larger data set. By characterizing the complications and providing values for their total occurrences, patients and physicians may have more realistic expectations for the outcomes and morbidity of this device.
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Affiliation(s)
- Mickey Abraham
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Justin Gold
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
| | - Jack Dweck
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Max Ward
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Julian Gendreau
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Neal Panse
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Keshav Holani
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Priya Gupta
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Antonios Mammis
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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16
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Delhaas EM, Harhangi BS, Frankema SPG, Huygen FJPM, van der Lugt A. Catheter Access Port (Computed Tomography) Myelography in Intrathecal Drug Delivery Troubleshooting: A Case Series of 70 Procedures. Neuromodulation 2020; 23:949-960. [PMID: 32267597 PMCID: PMC7687167 DOI: 10.1111/ner.13153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/13/2022]
Abstract
Objectives Intrathecal drug delivery is used for the treatment of intractable spasticity, dystonia, and pain. When the symptomatology fails to respond to therapy, the cause could be failure of the medication infusion. The purpose of this study is to assess pump catheter access port (CAP)‐myelography and CAP‐CT‐myelography as advanced imaging methods in treatment failure. Materials and Methods We analyzed observational routinely collected data of 70 CAP procedures with 2D/3D reconstructions and additional imaging of 53 adult patients where the cause of treatment was unclear between November 2013 and November 2018. CAP‐myelography and CAP‐CT myelography were performed with postprocessing 2D/3D reconstructions. When myelography could not be obtained or when the result did not reveal the cause of the treatment failure, additional procedures, such as noncontrast CT, MRI, lumbar puncture CT, and 111Indium‐DTPA SPECT‐CT, were performed. Results CAP fluid aspiration prior to contrast medium injection was not possible (N = 17). In one case, contrast was injected into the pump pocket unintentionally (N = 1). Of 70 procedures, 24% were unaspiratable. The remaining CAP myelography examinations (N = 52) had limited value for the diagnosis. CAP‐CT myelography (N = 50) was normal (N = 31). The abnormal results (N = 19) were dorsal dural leak (N = 5), subdural catheter position (N = 2), limited rostral flow of contrast material (N = 4), limited and abnormal contrast distribution (N = 3), obstruction of rostral flow (N = 2), a leak at the pump‐catheter connection (N = 1), and a sheared catheter localized in the pump pocket (N = 2). Limited contrast distributions were found to be false positive findings (N = 2). Four normal CT‐CAP myelographic procedures were false negatives, as the reference tests revealed a cause of intrathecal drug delivery (ITDD) failure. The CAP‐CT procedures resulted in a sensitivity of 81% (17/21) and a specificity of 93% (27/29). Conclusions CAP‐CT myelography with 2D/3D reconstructions is an essential step in the diagnostic algorithm for cases involving ITDD failure.
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Affiliation(s)
- Elmar M Delhaas
- Center for Pain Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Biswadjiet S Harhangi
- Department of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sander P G Frankema
- Center for Pain Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J P M Huygen
- Center for Pain Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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18
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Kim JH, Jung NY, Chang WS, Jung HH, Cho SR, Chang JW. Intrathecal Baclofen Pump Versus Globus Pallidus Interna Deep Brain Stimulation in Adult Patients with Severe Cerebral Palsy. World Neurosurg 2019; 126:e550-e556. [DOI: 10.1016/j.wneu.2019.02.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/29/2022]
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19
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Frizon LA, Sabharwal NC, Maiti T, Golubovsky J, May F, Shao J, Machado AG, Nagel SJ. Removal of Intrathecal Catheters Used in Drug Delivery Systems. Neuromodulation 2018; 21:665-668. [DOI: 10.1111/ner.12799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/25/2018] [Accepted: 05/09/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Leonardo A. Frizon
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic; Cleveland OH USA
| | | | - Tanmoy Maiti
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic; Cleveland OH USA
| | | | - Francis May
- Cleveland Clinic Lerner College of Medicine; Cleveland OH USA
| | - Jianning Shao
- Cleveland Clinic Lerner College of Medicine; Cleveland OH USA
| | - Andre G. Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic; Cleveland OH USA
| | - Sean J. Nagel
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic; Cleveland OH USA
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20
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Shao J, Frizon L, Machado AG, McKee K, Bethoux F, Hartman J, Nagel SJ. Occlusion of the Ascenda Catheter in a Patient with Pump Twiddler's Sydrome: A Case Report. Anesth Pain Med 2018; 8:e65312. [PMID: 30027067 PMCID: PMC6045776 DOI: 10.5812/aapm.65312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/05/2018] [Accepted: 04/22/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Intrathecal baclofen (ITB) therapy is an effective way to manage spasticity in numerous conditions, including multiple sclerosis, stroke, and cerebral palsy. While pump failure is a common complication of ITB, improvements in device design have led to reduction of complications. In particular, the Ascenda catheter from Medtronic, Inc. was designed to resist kinking and associated complications; indeed, no incidences of catheter twisting or occlusion have been reported in literature prior to this case. Case Report We report a case of a 32-year old gentleman who presented to the clinic with symptoms of baclofen withdrawal 19 months after he had a programmable pump implanted for spasticity. During the diagnostic evaluation it was discovered that the patients pump had flipped in his abdominal pocket. He was taken to surgery to reorient the pump, during which time it was noted the catheter was tightly coiled on itself occluding flow. The twisted catheter was excised and replaced with a new segment.His symptoms subsequently resolved. Conclusions Although catheter occlusions have subsided since the approval of the Ascenda catheter, pump twiddler's syndrome remains a risk factor for this complication. This is the first report describing this syndrome in a patient with the Ascenda catheter.
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Affiliation(s)
- Jianning Shao
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
- Corresponding author: Jianning Shao, B.A., Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 44195, 9980 Carnegie Ave, Cleveland, OH. Tel: +1-8474360396, Fax: +1-216444.1015, E-mail:
| | - Leonardo Frizon
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Andre G. Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Keith McKee
- Mellen Center, Cleveland Clinic, Cleveland, OH
| | | | | | - Sean J. Nagel
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH
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21
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A case of neglected silicone tube in lacrimal duct for 20 years. Am J Ophthalmol Case Rep 2018; 11:41-44. [PMID: 29984331 PMCID: PMC6026770 DOI: 10.1016/j.ajoc.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 03/18/2018] [Accepted: 05/21/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose To report a case of prolonged placement of a lacrimal silicone tube for 20 years, with evaluation of the lacrimal duct using lacrimal micro-endoscopy and inspection of deformation of the lacrimal tube. Observations This study involved a case of dacryocystitis in which a silicone tube had been placed in the patient 20-years previous and that was treated conservatively. Although granulation tissue formation due to dacryocystitis in the lacrimal duct was observed under lacrimal micro-endoscopy, subjective and objective resolution of symptoms, including granulated tissue formation, was achieved after removal of the silicone tube and conservative medical treatment. Follow-up examinations performed over a 12-month period post treatment revealed no recurrence of epiphora or anatomical obstruction. Inspection of the lacrimal tube using the tension test revealed minimal changes in the tube in situ for 20 years. Conclusions and Importance The findings in this case suggest both the lacrimal system and the silicone tube are tolerant to prolonged intubation, as long as the tube had been placed properly with careful observation. Our findings may encourage physicians to consider prolonged intubation for select cases of nasolacrimal duct obstruction.
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22
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Pucks-Faes E, Hitzenberger G, Matzak H, Fava E, Verrienti G, Laimer I, Fritz J, Saltuari L. Eleven years' experience with Intrathecal Baclofen - Complications, risk factors. Brain Behav 2018; 8:e00965. [PMID: 29761017 PMCID: PMC5943769 DOI: 10.1002/brb3.965] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/29/2017] [Accepted: 01/04/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Treatment with intrathecal baclofen (ITB) is commonly used in patients with severe spasticity. However, complications may occur after implantation of the ITB-device, albeit mainly procedure- and device-related problems. The aim of the study was to assess surgical- as well as catheter- and pump-related complications and define their risk factors. METHODS We retrospectively evaluated all patients with an implanted ITB-device who were treated at the Department of Neurology, Hochzirl Hospital, Zirl, Austria, between 2006 and 2016. RESULTS Twenty-nine of 116 (25%) patients experienced 32 complications: 5 procedure- and 27 device-related (4 pump- and 23 catheter-associated) problems occurred. Risk factors for sustaining any complication were a spinal localization of lesion (odds ratio [OR] OR 2.71, p = .021), other catheter types than an Ascenda® catheter (OR 3.87, p = .041), a lower modified Rankin Scale (median 4 vs. 5; OR 2.86, p = .015) and a higher Barthel Index (median 53 vs. 0; OR 2.84, p = .006). The median time from the last ITB-related surgery to the first complication was 18 (IQR 1-57) months. Overall, 47% complications occurred within the first year after any surgical procedure regarding the ITB-device, thereof 25% within the first month. CONCLUSIONS Procedure- and device-related complications are frequent after implantation of an ITB-device with catheter-associated complications as the most frequently encountered problems. Patients with a spinal origin of spasticity, a lower modified Rankin Scale and a higher Barthel Index have a higher risk to sustain a complication.
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Affiliation(s)
| | | | | | - Elena Fava
- Department of Neurology Hochzirl Hospital Zirl Austria
| | | | - Ilse Laimer
- Department of Neurosurgery Medical University Innsbruck Innsbruck Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics Medical University Innsbruck Innsbruck Austria
| | - Leopold Saltuari
- Department of Neurology Hochzirl Hospital Zirl Austria.,Research Unit for Neurorehabilitation South Tyrol Italy
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23
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Towns M, Rosenbaum P, Palisano R, Wright FV. Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy? Dev Med Child Neurol 2018; 60:147-154. [PMID: 29105760 DOI: 10.1111/dmcn.13602] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system. WHAT THIS PAPER ADDS The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.
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Affiliation(s)
- Megan Towns
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Robert Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Physical Therapy and Rehabilitation Science Department, Drexel University, Philadelphia, PA, USA
| | - F Virginia Wright
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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24
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Delhaas EM, Harhangi BS, Frankema SPG, Huygen FJPM, van der Lugt A. Plain radiography in patients treated with intrathecal drug delivery using an implantable pump device. Insights Imaging 2017; 8:499-511. [PMID: 28840489 PMCID: PMC5621993 DOI: 10.1007/s13244-017-0568-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Intrathecal drug administration using an implanted pump system is well established in intractable spasticity and pain. However, despite continuous advancements in manufacturing technology, adverse events related to the pump and catheter still occur. Most of them, such as migration, damage, disconnection and occlusion, are related to the spinal catheter. The aim of this overview is to update radiologists on how plain radiography of the implanted delivery system for intrathecal drug administration should be interpreted and to increase awareness for the need of urgent and timely multidisciplinary troubleshooting. METHODS Plain radiographic images of patients treated with intrathecal drug administration using an implantable drug delivery system were analysed in a multidisciplinary setting at our (university) referral centre for complications in intrathecal drug administration. RESULTS Examples of catheter-related adverse events are described and a proposal is made for stepwise interpretation of standard plain radiographic images. CONCLUSIONS Plain radiological images are the mainstay for the diagnosis of catheter-related adverse events in intrathecal drug delivery. Radiologists play an important role in an early diagnosis. An awareness of abnormal radiological findings seems important to avoid a life-threatening withdrawal syndrome. TEACHING POINTS • Untimely cessation of intrathecal drug delivery can lead to a life-threatening withdrawal syndrome. • Initially mild symptoms can lead to an exacerbation of a withdrawal syndrome. • Most intrathecal catheter-related problems are visible on plain radiography. • Common causes of catheter problems are migration, lacerations, occlusion and disconnection. • Knowledge on implanted intrathecal catheters is crucial for interpretation of plain radiography.
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Affiliation(s)
- Elmar M Delhaas
- Center for Pain Medicine, Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Biswadjiet S Harhangi
- Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sander P G Frankema
- Center for Pain Medicine, Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Frank J P M Huygen
- Center for Pain Medicine, Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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25
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Nagel SJ, Reddy CG, Frizon LA, Holland MT, Machado AG, Gillies GT, Howard MA. Intrathecal Therapeutics: Device Design, Access Methods, and Complication Mitigation. Neuromodulation 2017; 21:625-640. [DOI: 10.1111/ner.12693] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/26/2017] [Accepted: 07/29/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Sean J. Nagel
- Center for Neurological Restoration; Cleveland Clinic; Cleveland OH USA
| | - Chandan G. Reddy
- Department of Neurosurgery; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | | | - Marshall T. Holland
- Department of Neurosurgery; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Andre G. Machado
- Center for Neurological Restoration; Cleveland Clinic; Cleveland OH USA
| | - George T. Gillies
- Department of Mechanical and Aerospace Engineering; University of Virginia; Charlottesville VA USA
| | - Matthew A. Howard
- Department of Neurosurgery; University of Iowa Hospitals and Clinics; Iowa City IA USA
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26
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Draulans N, Theys T, Nuttin B, Kiekens C. Letter to the Editor: Ascenda catheter versus silicone catheter in intrathecal baclofen therapy. J Neurosurg Pediatr 2017; 19:269-270. [PMID: 27885944 DOI: 10.3171/2016.7.peds16390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Tom Theys
- University Hospitals Leuven, Pellenberg, Belgium
| | - Bart Nuttin
- University Hospitals Leuven, Pellenberg, Belgium
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