Disclosures: Bindiya Shah, DO: No financial relationships or conflicts of interest

Case Description: Patient presented urgently to clinic with increased spasticity. Per our troubleshooting algorithm, withdrawal from ITB was considered. Given noxious stimuli can also increase spasticity, patient’s E. Faecalis UTI was treated first. Symptoms did not resolve. Pump scan showed no alarms, reservoir volume was accurate, and imaging showed no discontinuity of the pump system. ITB was increased, oral Baclofen, Diazepam, and Dantrolene were prescribed, and UTI reoccurrence was treated. Patient’s condition worsened and a seroma formed overlying the pump site. Aspirate was positive for beta-2 transferrin, concerning for a CSF leak. Patient was admitted for revision of pump system and weaning of dose to prevent overdose post-operatively. Side port access revealed straw colored fluid return. CT of the pelvis showed no collection of fluid at the spine or pump. Surgeon agreed to explore the abdomen first and prepared to replace the catheter. In the OR, collette posterior to the pump was bent and catheter was fractured allowing CSF backflow into the abdomen.

Setting: Tertiary care academic hospital

Patient: 31 y/o male with spastic quadriplegia secondary to Cerebral Palsy and Spinal Cord Injury treated with intrathecal baclofen (ITB). Prior to ITB, patient experienced severe full-body extension spasms and lower>upper extremity spasticity. With ITB (221.96 mcg/day) spasticity was resolved.

Assessment/Results: Patient underwent catheter revision and pump dose was titrated up until spasticity was optimized.

Discussion: Utilization of a troubleshooting algorithm provides best practice/stepwise approach to address potential problems. Issues that do not align warrant critical thinking and clinical correlation to arrive at a logical conclusion of treatment. This problem has not previously been identified and demonstrates the importance of coordination between disciplines to prevent extensive procedures and overdose after surgery.

Conclusion: Critical thinking, clinical correlation, and strong communication amongst all providers within a care team should be utilized with a troubleshooting algorithm to improve ITB outcomes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/previously-unseen-catheter-malfunction-of-an-intrathecal-baclofen-pump-system-a-case-report/