Presented at the 2012 AAPM Annual Meeting « Back

Compressive Cervical Myelopathy from a CSF Leak in a Patient with an Intrathecal Baclofen Pump System

Alexis A. Jimenez, MD, jimenez.alexis@mayo.edu¹, Jason S. Eldrige, MD¹, Matthew J. Pingree, MD¹, (1) Mayo Clinic, Rochester, Minnesota

Objective: Present a case of compressive cervical myelopathy due to an epidural fluid collection around an intrathecal baclofen pump catheter. Background: Intrathecal baclofen systems have been effectively used since the mid-1980s to treat patients with severe spasticity, but there are still significant complications associated with the surgical technique and prolonged duration of treatment. Case Report: The patient is a 46-year-old female with a history of hereditary spastic paraparesis who was diagnosed at age 26. She underwent intrathecal baclofen pump placement in 2002 and complete system replacement in 2008. Physical examination revealed severely spastic lower extremities with intrinsic hand muscle weakness on the left. CT myelogram showed extraarachnoid contrast from the C3 cervical level to the L2 level. After CT results a T12-L1 laminectomy and repair of cerebral spinal fluid (CSF) leak was performed complicated in Day 1 by worsening of spasticity. A dye study was performed and suggested leaking at the pump-catheter interface. Patient underwent a reexploration and a catheter fracture was repaired. After the above surgical interventions, the patient noticed improvement of her spasticity and gradually titrated off her PO baclofen. At the time of her discharge, spasticity was nicely controlled at 119.95 mcg per day of intrathecal baclofen. Conclusion: Intrathecal baclofen systems are effective in treating medically refractory spasticity. For chronic CSF fluid collections in the epidural space with evidence of cord compression, the treatment may require an invasive surgical approach. Such was the case with our patient, who required laminectomy with dural repair and baclofen pump system revision. References: 1)1. Neil Haranhalli, Dhanya Anand, Jeffrey H. Wisoff, David H. Harter, Howard L. Weiner, Michelle Blate and Jonathan Roth. Intrathecal baclofen therapy: complication avoidance and management. Childs Nerv Syst. 2011 Mar;27(3):421-7. Epub 2010 Sep 18 2)2.McCormack BM, Taylor SL, Heath S, Scanlon J. Pseudomeningocele/CSF Fistula in a Patient With Lumbar Spinal Implants Treated With Epidural Blood Patch and a Brief Course of Closed Subarachnoid Drainage: A Case Report. Spine (Phila Pa 1976). 1996 Oct 1;21

Funding: None