About the Intrathecal Baclofen Pump

Symptoms: A malfunctioning intrathecal baclofen pump may present with increased spasticity, unusual sensations near the pump site, or visible symptoms such as swelling or leakage.

Causes: Issues typically stem from medication-related factors, such as formulation variations, or mechanical problems, including catheter displacement or obstruction.

Remedies: Prompt medical evaluation is necessary to determine the underlying issue. Potential solutions may include pump replacement, adjustments to settings, and short-term medications to alleviate symptoms.

Procedure for Intrathecal Baclofen Pump

Preoperative Evaluation: Before the surgery, patients undergo a thorough assessment by a multidisciplinary team, including a neurosurgeon, physiatrist, and anesthesiologist. This evaluation focuses on the patient’s neurological status, medical history, and previous response to oral baclofen therapy.

Patient Selection: Candidates for implantation are typically those experiencing severe spasticity who are either intolerant to oral medications or unresponsive to them. Common conditions include spinal cord injuries, multiple sclerosis, traumatic brain injuries, and cerebral palsy.

Surgical Implantation: The procedure is performed under either conscious sedation or general anesthesia. A catheter is inserted into the intrathecal space surrounding the spinal cord through a small incision in the lumbar area of the back. A pump is then implanted subcutaneously in the chest or abdomen and connected to the catheter.

Trial Period: Before the permanent pump is implanted, a temporary catheter may be used for a trial period. This allows the medical team to assess the effectiveness of intrathecal baclofen therapy in improving function and reducing spasticity.

Programming and Titration: After implantation, an external programmer is used to adjust the dosage of baclofen delivered into the intrathecal space. Titrating the dosage over time ensures optimal symptom control with minimal side effects.

Postoperative Care: Following surgery, patients are closely monitored for complications such as infection, cerebrospinal fluid leakage, or device malfunction. Early rehabilitation therapy is often initiated to maximize functional benefits.

Long-term Management: Routine follow-up appointments are scheduled to evaluate the patient’s response to the therapy and to make necessary adjustments to pump settings. The baclofen reservoir typically needs to be refilled every few months, depending on dosage and pump capacity. Patients and caregivers receive information on emergency protocols, pump maintenance, and identifying potential complications.