Disclosures: Clifford R. Kissling, MD: No financial relationships or conflicts of interest

Case Description: Two years after injury, an intrathecal pump was placed and the patient transitioned to IRF. For the first five days, at 100 mcg/d of intrathecal baclofen, he was pleased with spasticity control and activity level. On post-op day five, he developed lumbar pain and spasms. Oral medications for pain and spasticity and therapeutic modalities were tried but ineffective. Pain was described as being localized to the lumbar region with no radiation down the legs. Bed mobility became difficult. MRI could not be obtained due to a non-compatible pacemaker. After three weeks, a CT myelogram via catheter port was completed and demonstrated, “diffuse clumping and thickening of cauda equina roots with a slight loculation impressive of arachnoiditis.” CSF showed the following: protein: 519 mg/dL, WBC: 9/μL, with negative gram stain and cultures. ESR and CRP were 97 mm/Hr and 5.63 mg/dL respectively. Prednisone was initiated to treat arachnoiditis. Pain was relieved with 60 mg of prednisone daily but recurred when tapered. The pump was explanted after six weeks. Due to functional decline, he was transferred to a skilled nursing facility. After two months, his inflammatory markers improved but remained elevated. After five months without clinical improvement, a repeat CT myelogram showed destructive L2-L3 osteomyelitis.

Setting: Outpatient clinic & Inpatient Rehabilitation Facility (IRF)

Patient: 70 year old with three year history of central cord syndrome Assessment/

Results: Due to destructive osteomyelitis, intraoperative stabilization was performed. Intraoperative cultures were negative, however intraoperative samples showed PCR-positive Staphylococcus. Intravenous antibiotics were initiated and five weeks post-op, pain had completely resolved.

Discussion: This is a unique case of early osteomyelitis following intrathecal pump placement. There are no literature reports of osteomyelitis developing acutely after pump implant.

Conclusion: Complications of baclofen pump implant usually involve skin infections. This case represents a far more serious adverse outcome.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/lumbar-osteomyelitis-directly-after-baclofen-pump-placement-a-case-report/