Obstructed catheter connection pin discovered during intrathecal baclofen pump exchange

Abstract

We report a case of catheter obstruction due to complete narrowing of the lumen of a connecting pin, and catheter disconnection in a patient undergoing intrathecal Baclofen pump exchange. The patient underwent intrathecal baclofen pump implantation for treatment of lower extremity spasticity and hypertonia secondary to congenital tetraplegia. Intrathecal baclofen dose escalation occurred over the course of treatment (73 mo) from 80 to 708 mcg/d representing a 189% increase in dose. The pump had neared the manufacturer's recommended exchange interval; therefore, a pump exchange was scheduled to surgically replace the device. One week before surgery, the patient noted a distinct increase in his symptomatology and began enteral baclofen therapy. During the surgery, the pump catheter was noted to be disconnected from the pump. Upon further examination, the lumen of the connection pin positioned between the pump catheter and intrathecal catheter was completely obstructed. Postsurgically, the patient's intrathecal baclofen dose was substantially reduced from 708 to 527 mcg/d (25.6% reduction) to control hypotonicity and to reestablish an Ashworth score of 2. We discuss intrathecal baclofen therapy and a unique complication associated with a catheter connecting pin.