Intrathecal Drug Delivery System: Surgical Technique

Blood Patch

A postdural puncture headache (PDPH) is a well-described complication after implantation of an intrathecal drug delivery system (IDDS). Treatment is typically with supportive management with the occasional need for an epidural blood patch. We describe a case of a patient with refractory muscle spasticity secondary to cerebral palsy that required a baclofen IDDS implantation and subsequently developed a PDPH. After failing conservative therapy as well as an epidural blood patch, the decision was made to attempt an epidural fibrin patch, which transiently improved her headache. Upon return of the patient’s symptoms, computed tomography myelogram demonstrated an extensive cerebrospinal fluid leak with ventral spread into the retroperitoneal space. Using a novel technique, a second epidural fibrin glue patch was administered just adjacent to the IDDS catheter insertion point, which was then successful in resolving her symptoms. Key words: Intrathecal drug delivery system, postdural puncture headache, dural tear, cerebrospinal fluid (CSF) leak, fibrin glue, epidural blood patch

117 Placement of an Intrathecal Drug Delivery System

Atlas of Neurosurgical Techniques ◽

10.1055/b-0036-136839 ◽

2016 ◽

Keyword(s):

Drug Delivery ◽

Drug Delivery System ◽

Delivery System ◽

A Case Report of Reticular Telangiectatic Erythema Following Intrathecal Drug Delivery System Reservoir Replacement

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13166 ◽

2020 ◽

Vol 23 (7) ◽

pp. 1054-1056

Author(s):

Logan Kinch ◽

Lynn Kohan

Keyword(s):

Drug Delivery ◽

Case Report ◽

Drug Delivery System ◽

Delivery System ◽

Poster 413 Human Factors Research to Improve Programming and Variable Drug Dosing for an Intrathecal Drug Delivery System

PM&R ◽

10.1016/j.pmrj.2011.08.443 ◽

2011 ◽

Vol 3 ◽

pp. S318-S318

Author(s):

Sarah Alme ◽

Ajinkya Joglekar

Keyword(s):

Drug Delivery ◽

Human Factors ◽

Drug Delivery System ◽

Delivery System ◽

Drug Dosing ◽

Human Factors Research

Pontine Hemorrhage Following a Recently Implanted Intrathecal Drug Delivery System

Pain Practice ◽

10.1111/j.1533-2500.2009.00290.x ◽

2009 ◽

Vol 9 (4) ◽

pp. 312-316 ◽

Cited By ~ 4

Author(s):

David M. Rosenfeld ◽

Terrence Trentman ◽

Naresh P. Patel

Keyword(s):

Drug Delivery ◽

Drug Delivery System ◽

Delivery System ◽

Pontine Hemorrhage

Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience

Pain Research and Treatment ◽

10.1155/2016/2134959 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Markus A. Bendel ◽

Susan M. Moeschler ◽

Wenchun Qu ◽

Eugerie Hanley ◽

Stephanie A. Neuman ◽

...

Keyword(s):

Drug Delivery ◽

Drug Delivery System ◽

Delivery System ◽

Epidural Blood Patch ◽

Demographic Data ◽

Success Rates ◽

Postdural Puncture Headache ◽

Invasive Treatment ◽

Blood Patch

A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage needed invasive treatment with an epidural blood patch (EBP). There is limited data to describe the technical details, success rates, and complications associated with EBP in this population. This study aims to provide a retrospective report of EBP for patients suffering from PDPH related to IDDS implantation. A chart review established a cohort of patients that required EBP in relation to a PDPH after IDDS implantation. This cohort was evaluated for demographic data as well as details of the EBP including technical procedural data, success rates, and complications. All patients received a trial of conservative therapy. Standard sterile technique and skin preparation were utilized with no infectious complications. The EBP was placed below the level of the IDDS catheter in 94% of procedures. Fluoroscopy was utilized in each case. The mean EBP volume was 18.6 cc and median time of EBP was day 7 after implant. There were no complications associated with EBP. EBP appears to be an effective intervention in this subset of PDPH patients.

Efficacy of intrathecal drug delivery system for refractory cancer pain patients: A single tertiary medical center experience

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2011.03.005 ◽

2012 ◽

Vol 111 (5) ◽

pp. 253-257 ◽

Cited By ~ 11

Author(s):

Chih-Peng Lin ◽

Wen-Ying Lin ◽

Feng-Sheng Lin ◽

Yow-Shan Lee ◽

Chuen-Shin Jeng ◽

...

Keyword(s):

Drug Delivery ◽

Cancer Pain ◽

Drug Delivery System ◽

Delivery System ◽

Medical Center ◽

Pain Patients

Cerebrospinal Fluid Leak Presenting with Radiculitis and Delayed Onset Headache Following Intrathecal Pump Implantation

Pain Management Case Reports ◽

10.36076/pmcr.2017/1/89 ◽

2017 ◽

pp. 89-92

Author(s):

Laura Anne Lynem

Keyword(s):

Drug Delivery ◽

Drug Delivery System ◽

Delivery System ◽

Dural Puncture ◽

Fluid Collection ◽

Laboratory Evaluation ◽

Csf Leak ◽

Access Port ◽

Lower Back ◽

The issue of cerebrospinal fluid (CSF) leak due to catheter-related failure persists despite new approaches to surgical techniques. There is limited literature about atypical presentations of post dural puncture headaches post intrathecal drug delivery system (IDDS) implantation. A 59-year-old woman with a past medical history of lumbar postlaminectomy syndrome, chronic pain, and lower back pain underwent an intrathecal drug delivery system implantation after exhausting other modalities for pain relief. The patient presented to the office one-month postoperatively with symptoms of lower back pain, left lower extremity radiculopathy, and lower back subcutaneous fluid collection. A dye study using catheter access port access revealed a patent intrathecal catheter with no fluid leakage or collection after injecting contrast dye through the catheter access port. A fine needle aspiration performed under ultrasound guidance revealed a clear fluid. Using laboratory evaluation, this was confirmed to be CSF using laboratory evaluation. An epidural blood patch was performed, which provided minimal radicular pain relief. Several days after, she began experiencing fronto-occipital headaches and the lumbar fluid collection reaccumulated. An intrathecal dye study again was done and showed retrograde flow from the catheter causing a lumbar fluid collection. A catheter exchange was performed resolving the CSF leak and the patient’s symptoms. Post dural puncture headaches after IDDS implantation may have an atypical presentation. Providers should ensure the intrathecal catheter is well secured and firmly anchored to prevent migration. Patient symptoms after IDDS implantation may necessitate further investigation, including: patient evaluation, confirming catheter continuity, and minimally invasive or surgical management. Complications from IDDS may be reduced with further research on equipment and implantation techniques. Key words: Intrathecal drug delivery system, neuraxial analgesia, chronic pain, post dural puncture headache, post laminectomy syndrome, intrathecal catheters

Intrathecal Pump Exposure to Electromagnetic Interference: A Report of Device Interrogation following Multiple ECT Sessions

January 2018 - Pain Physician ◽

10.36076/ppj/2016.19.e343 ◽

2019 ◽

Vol 19 (2;2) ◽

pp. E343-E345

Author(s):

Mark Bicket

Keyword(s):

Drug Delivery ◽

Case Report ◽

Drug Delivery System ◽

Delivery System ◽

Electroconvulsive Therapy ◽

Electromagnetic Interference ◽

Drug Delivery Systems ◽

Safety Issue ◽

Delivery Systems ◽

Background: Intrathecal drug delivery systems represent an increasingly common treatment modality for patients with a variety of conditions, including chronic pain and spasticity. Pumps rely on electronic programming to properly control and administer highly concentrated medications. Electromagnetic interference (EMI) is a known exposure that may cause a potential patient safety issue stemming from direct patient injury, pump damage, or changes to pump operation or flow rate. Objectives: The objective of our case report was to describe an approach to evaluating a patient with a pump prior to and following exposure to EMI from electroconvulsive therapy (ECT), as well as to document findings from device interrogations associated with this event. Study Design: Case report. Setting: Academic university-based pain management center. Results: We present the case of a patient with an intrathecal pump who underwent multiple exposures to EMI in the form of 42 ECT sessions. Interrogation of the intrathecal drug delivery system revealed no safety issues following ECT sessions. At no time were error messages, unintentional changes in event logs, unintentional changes in pump settings, or evidence of pump stall or over-infusion noted. Conclusion: Communication with multiple entities (patient, family, consulting physicians, and device manufacturer) and maintaining vigilance through device interrogation both before and after EMI exposure are appropriate safeguards to mitigate the risk and detect potential adverse events of EMI with intrathecal drug delivery systems. Given the infrequent reports of device exposure to ECT, best practices may be derived from experience with EMI exposure from magnetic resonance imaging (MRI). Although routine EMI exposure to intrathecal drug delivery systems should be avoided, we describe one patient with repeated exposure to ECT without apparent complication. Key words: Baclofen, intrathecal drug delivery system, electromagnetic interference, electroconvulsive therapy, safety, pump interrogation, intrathecal pump, pump stall

Intrathecal Drug Delivery System: A Pain Management Option for Refractory Cancer-Related Pain

Pain Medicine ◽

10.1093/pm/pnaa364 ◽

2020 ◽

Author(s):

Robalee L Wanderman ◽

Jonathan M Hagedorn

Keyword(s):

Drug Delivery ◽

Pain Management ◽

Drug Delivery System ◽

Delivery System ◽

World Health ◽

Refractory Pain ◽

System A ◽

Pain Medications ◽

Medication Side

Abstract Cancer-related pain is progressive and therefore requires a stepwise approach to management, such as the World Health Organization’s Pain Ladder. This approach calls for increasingly strong pain medications in addition to interventional options for patients with medication-refractory pain or intolerable medication side effects. Here, we discuss a case involving cancer-related pain which ultimately required intrathecal drug delivery system placement for optimal pain management.