507 - Utility of a Myelogram in Intrathecal Baclofen Screening Trials: A Case Series

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Corresponding Author(s)

KB

Kaylie A. Bullock, MD

Resident, PGY-3
Indiana University School of Medicine
Carmel, Indiana, United States

Presenting Author(s)

ZW

Zachary Ward, DO

Resident Physician
Indiana University
Indianapolis, Indiana, United States

Co-Author(s)

NL

Nicole LaRue, MS, BS

OMS-III
Marian University Wood College of Osteopathic Medicine
Indianapolis, Indiana, United States

Presenting Author(s)

SD

Shashank Dave, DO

Associate Clinical Professor
Indiana University School of Medicine
Indianapolis, Indiana, United States

Submitter(s)

KB

Kaylie A. Bullock, MD

Indiana University Dept of PM&R
Carmel, Indiana, United States

Case Diagnosis: This case series describes two patients referred for intrathecal baclofen (ITB) screening trials who had ‘dry-taps,’ where no free-flowing nor aspirated cerebrospinal fluid (CSF) was returned upon lumbar puncture, despite confirmation of needle placement under fluoroscopy.

Case Description: Patient A was a 40-year-old male with spastic diplegia secondary to cerebral palsy and history of dorsal rhizotomy, L1-L2 laminectomy and fusion, then T11-L3 fusion. Patient B was a 50-year-old male with an incomplete, traumatic thoracic spinal cord injury and history of T9-12 fusion. Both patients failed oral antispasmodic agents as well as botulinum toxin injections and then were referred for ITB trial. In both cases, entry into the intrathecal space was attempted at two adjacent lumbar levels using fluoroscopy. Despite visualization of needle depth on multiple fluoroscopic views, no CSF was returned. On the third attempt, non-ionic contrast was injected and demonstrated a characteristic myelogram flow pattern, confirming accurate needle placement within the intrathecal space. 50mcg of baclofen was injected and both patients had positive responses to the trial resulting in recommendation for ITB pump placement.

Discussions: Dry-tap may occur for a variety of reasons, such as dehydration and prior spinal procedures as in these cases. If dry-tap occurs during an ITB trial, this may prevent it from proceeding and exclude patients from further consideration of an ITB pump for effective spasticity management. Rather than abort the procedure, myelogram in these cases provided an alternative method for needle placement confirmation and allowed the trials to proceed.

Conclusions:
For ITB trial patients with risk factors for dry-tap, myelogram may be considered during pre-procedure planning. To our knowledge, this approach has not been described in the medical literature for ITB trials previously.