813 - Breaking Point: Understanding Baclofen Pump Failure Due to Catheter Compromise, a Case Report

Intrathecal Baclofen (ITB) Withdrawal Secondary to Suspected Intraoperative Tool-Induced Broken Catheter-related Complication (CRC)

Case Description:

An 18-year-old male with mixed spastic-dyskinetic quadriplegic cerebral palsy was admitted for routine ITB pump exchange due to end-of-battery life. The catheter functioned normally pre-operatively and intraoperatively, as confirmed by a catheter access port (CAP) study and priming bolus. Postoperatively, he showed signs of ITB withdrawal, including agitation, spasticity, flushing, tachycardia, hypoxia, urinary retention, and constipation. Pump interrogation and infectious evaluations were unremarkable. Imaging on postoperative day two suggested a catheter disconnection, but this was dismissed as a false positive. Persistent withdrawal prompted further tests, and a CAP trial failed to yield cerebrospinal fluid. CT ultimately revealed an 11-centimeter disconnection in the abdominal catheter tubing. Revision surgery restored the catheter’s integrity, and ITB titration was resumed.

Discussions:

This case highlights the essential role of PM&R in troubleshooting ITB pumps. Physiatrists are often first to recognize withdrawal symptoms and distinguish them from infection, pain, or autonomic dysfunction. Their expertise in spasticity management, systems interrogation, and withdrawal physiology enables a systematic evaluation when initial tests are normal. Standard troubleshooting algorithms emphasize pump interrogation and CAP studies before imaging, but this case shows that early, low-cost imaging can expedite diagnosis of catheter-related problems. Beyond immediate management, PM&R also helps with safe bridging using oral agents, monitors tone and withdrawal during weaning, and ensures smooth re-titration of intrathecal doses after revision. By involving physiatrists earlier in the diagnostic process, delays in detecting catheter issues can be minimized, enhancing patient safety and improving long-term results.

Conclusions:

Current troubleshooting approaches place imaging late in the process. Because plain radiographs are inexpensive and highly diagnostic, routine postoperative imaging should be considered to create a baseline for future pump assessments and identify early catheter-related issues.