Indented intrathecal drug delivery system with loss of reservoir volume

2019 ◽  
Vol 44 (7) ◽  
pp. 747-749
Author(s):  
Vasudha Goel ◽  
Amol M Patwardhan ◽  
Mohab Ibrahim ◽  
Hariharan Shankar ◽  
David M Schultz
Keyword(s):  
Drug Delivery ◽  
Back Pain ◽  
Drug Delivery System ◽  
Delivery System ◽  
Pain Control ◽  
Case Reports ◽  
Battery Life ◽  
Reservoir Volume ◽  
Intrathecal Drug Delivery ◽  
Failed Back Surgery

ObjectivesWe report two patients who underwent elective revision surgery were found to have reduced reservoir volumes and indented bottom shield of intrathecal drug delivery system (IDDS).Case reportsCase #1: A 59-year-old man stable on IDDS medications for chronic neck and upper back pain was found to have an irreversible reduction in reservoir volume from 40 to 28 cc on routine refill appointment. Despite having stable pain control, the reservoir volume decreased from 40 to 22 cc and subsequently to 17 cc when the patient had inadequate pain control. During replacement surgery, the posterior shield of the IDDS was found to be collapsed. The patient had exposure to hyperbaric oxygen treatments for chronic non-healing wounds of the lower extremities. Case #2: A 68-year-old woman had an IDDS implanted for chronic low back pain secondary to failed back surgery syndrome. The reservoir volume was found to be reduced to 15 cc of medication from 20 cc during the seventh year of therapy. There was a report of a fall. Routine reservoir exchange at the end of battery life revealed that the bottom shield of the reservoir was indented.ConclusionsInability to refill the medication to full capacity should be an indication to investigate device deformation. Information about exposure to hyperbaric therapy or local trauma should be obtained.

Multiple Fibrin Glue Use in a Complicated Case of Postdural Puncture Headache Following Intrathecal Drug Delivery System Placement: A Case Report

2019 ◽  
pp. 77-81
Author(s):  
Matthew Chung
Keyword(s):  
Drug Delivery ◽  
Cerebrospinal Fluid ◽  
Drug Delivery System ◽  
Fibrin Glue ◽  
Delivery System ◽  
Epidural Blood Patch ◽  
Csf Leak ◽  
Postdural Puncture Headache ◽  
Intrathecal Drug Delivery ◽  
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

Pontine Hemorrhage Following a Recently Implanted Intrathecal Drug Delivery System

Pain Practice ◽  
2009 ◽  
Vol 9 (4) ◽  
pp. 312-316 ◽  
Author(s):  
David M. Rosenfeld ◽  
Terrence Trentman ◽  
Naresh P. Patel
Keyword(s):  
Drug Delivery ◽  
Drug Delivery System ◽  
Delivery System ◽  
Intrathecal Drug Delivery ◽  
Pontine Hemorrhage

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

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
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 ◽  
Intrathecal Drug Delivery ◽  
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.

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

2012 ◽  
Vol 111 (5) ◽  
pp. 253-257 ◽  
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 ◽  
Intrathecal Drug Delivery ◽  
Pain Patients

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

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 ◽  
Intrathecal Drug Delivery

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

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