Intrathecal Pump Movement After Placement: Diagnosis and Treatment

ITPs are implantable mechanical systems used to infuse analgesic medications into the intrathecal space

The Implantable Systems Performance Registry monitors complications and adverse performance events

Estimated to occur in 11.6% of patients [1]

46 year old female with ITP placement for cancer pain

Clinic visit 5 months after implantation: decreased pain control and PTM not working, unable to interrogate device, physical exam: device upside down

Manually corrected orientation

One day later: patient presented to ED for back pain

X-Ray: ITP sideways in pocket

Patient admitted and taken to OR for revision

Catheter found to be severely twisted

Catheter untangled and shortened

Pump sutured to all four corners of pocket

Follow up clinic visit: increased pain relief, pump correctly positioned on physical exam

ITP patient presenting with increased pain: pump inversion and catheter kinking should be considered in differential

Catheter kinking: 3.5% incidence [1]

ITP inversion: 0.03% incidence [1]

Work up: physical exam, physician interrogation device, aspiration of ITP medication, dye study, and imaging

Management:

Manual correction of inversion

Surgical revision

Untangling catheter

Shortening catheter length

Anchoring pump