Journal of Spine & NeurosurgeryISSN: 2325-9701

Case Report, J Spine Neurosurg Vol: 4 Issue: 5

Intra-Operative Computed Tomography Confirmation of Intrathecal Drug Delivery System Catheter

Tambrea T. Ellison1, Nathan J. Neufeld2, Yousef Salimpour3, William S. Anderson3* and Richard D. Zorowitz4
1Georgia Pain Physicians of Marietta, 2550 Windy Hill Road, Marietta, USA
2Medical Director for Cancer Pain, Cancer Treatment Centers of America, Newnan, USA
3Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
4Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, USA
Corresponding author : William S. Anderson
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
Tel: 443-287-1609; Fax: 443-287-8044
E-mail: [email protected]
Received: June 15, 2015 Accepted: December 11, 2015 Published: December 17, 2015
Citation: Ellison TT, Neufeld NJ, Salimpour Y, Anderson WS, Zorowitz RD, et al. (2015) Intra-Operative Computed Tomography Confirmation of Intrathecal Drug Delivery System Catheter. J Spine Neurosurg 4:5. doi:10.4172/2325-9701.1000205

Abstract

A 56 year old female presented with severe continued spasticity after revision of an implanted intrathecal drug delivery system for baclofen administration. The patient suffered a left temporal intracerebral hemorrhage with subsequent right spastic hemiplegia, upper extremity worse than lower. She underwent an initial intrathecal drug delivery system implant with catheter placement at T10. The medication did not affect spasticity of the right upper extremity. Therefore, the catheter position was revised to T4. Following the procedure, the patient was transferred to a skilled nursing facility for medical management and intrathecal baclofen dose titration. Despite titration of baclofen, the spasticity still persisted. Imaging studies, including radiograph, computed tomography and Magnetic Resonance Imaging demonstrated that the catheter tip was adherent to the dorsal membranes, consistent with placement in the subdural space, but possibly not the subarachnoid space. During the second revision of the catheter, intraoperative-computed tomography imaging of the patient’s spine was used to confirm placement prior to closure. This technique clearly demonstrated that the intrathecal catheter entered through the laminectomy at T7 and terminated at T4 in the intrathecal space as anticipated. Future use of this technique may demonstrate the improper placement of an intrathecal drug delivery system catheter. This would allow immediate revision of the catheter and prevent unnecessary returns to the operating suite.

Keywords: Intraoperative computerized tomography; Spasticity; Intrathecal baclofen therapy

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