An intrathecally located broken catheter used for an intrathecal drug delivery system

Abstract

The intrathecal drug delivery system (ITDDS), an effective treatment tool for intractable spasticity and pain, is associated with various complications but breakage of the catheter is rare. We report the case of a 50-yr-old man with ITDDS, in whom an intrathecal catheter was severed, resulting in a 28.6-cm-long intrathecal fragment. The catheter completely retracted into the intrathecal space from the anchor site. The catheter was severed during spine flexion, and the total distal fragment was repositioned in the intrathecal space. Although the outcome of ITDDS was associated with the length or diameter of the broken catheter, no neurologic complications occurred in our patient. Thus, we inserted another catheter instead of removing the old one. Thereafter, the patient has been regularly followed up, and no neurologic complications have developed during the 28 months.

Keywords: Catheter; Complications; Implantable Infusion Pumps; Intrathecal Injections.

Fig. 1

A flowchart for checking for catheter continuity.

Fig. 2

Fluoroscopic images with injection of contrast media. The contrast medium is spread around the anchor (arrowhead). However, no contrast medium is noted in the intrathecal space. The broken intrathecal fragment is shown as a U-shaped loop (arrow).

Fig. 3

The broken anchor and proximal remnant of the catheter. (A) The broken anchor and catheter in the surgical field. (B) The broken anchor and proximal catheter after removal.