Resident Kingsbrook Jewish Med Ctr Brooklyn, New York, United States
Case Diagnosis: This is a case report of a 69 year old female with Intrathecal pump catheter break. She had multiple spine surgeries and she was deemed inoperable due to increased risk associated with catheter explanation and is being managed conservatively. There are only a few reported cases of intrathecal catheter break. This case highlights intrathecal catheter break which was managed conservatively.
Case Description: 69 year-old female with no history of trauma who presented with progressive neck pain and paresthesias in her arms. She had a history of a Drug Administration System (DAS, Baclofen pump) implantation in 2007 for cervical post laminectomy syndrome following cervical spinal fusion C5-C7 in 2003. MRI of the Cervical/Thoracic spine reported the upper tip of the intrathecal catheter extending to C2 level, with catheter break at the T8-T-9 level. Several neurosurgical opinions were obtained, she was deemed inoperable due to prior cervical spine surgeries and the elevated risk of spinal cord injury. The Baclofen pump is not in use at this time and she is currently on medical management for chronic pain and spasticity. She continues to remain neurologically stable.
Discussions: Drug delivery system catheter breaks can complicate the management of chronic pain, due to catheter migration and irritation of the nerve roots and potentially lead to new neurological deficits and worsening pain. Generally, catheter breaks do not provide a grim prognosis, but rapid assessment and interpretation are a priority in such cases. Neurosurgical evaluation is a priority in determination risk and benefits related to explanting a broken intrathecal catheter.
Conclusions: We report a case of a broken intrathecal catheter highlighting the potential complication of intrathecal drug device. While removal of the catheter may be an option, non-operative approach should be considered, if there is risk of spinal cord injury risk due to explantation of the migrated distal catheter.