513 - An Unexpected Encounter of Mechanical Alternative for Intrathecal Baclofen: A Case of Codman Pump Use in Spastic, Paraplegic Cerebral Palsy and Legacy Management

A middle-aged male with spastic paraplegic cerebral palsy, previously managed with a surgically implanted programmable Medtronic intrathecal baclofen pump (ITBP), was switched to a mechanical, non-programmable, now-discontinued Codman pump 13 years prior.

Case Description:

Cerebral Palsy is a neurological condition from brain damage during early development presenting with varying degrees of dystonia, gait abnormality, intellectual disability, and motor impairment. Oral baclofen is commonly used for spasticity management, but limited by poor blood-brain barrier penetration, reducing effects. Intrathecal baclofen pumps (ITBP) allow direct CSF administration, providing stronger benefit and fewer side effects. The patient had severe spasticity refractory to oral antispasmodics. A Medtronic pump was initially used, but he requested replacement with a mechanical Codman pump to avoid repeat surgeries. His spasticity was controlled at 0.39cc/day with baclofen concentration of 1040mcg. Modified Ashworth scale (MAS) 1 of knee extensors, otherwise 0 of both lower extremities.

Discussions:

The typical method for intrathecal baclofen delivery is an electronic, programmable Medtronic pump requiring replacement every 5–7 years. Codman pumps, commonly used for continuous chemotherapeutic infusions, provide a mechanical alternative for intrathecal baclofen. These pumps require no surgical replacement, function through body heat and fluid dynamics, and can be adjusted during refill appointments. A cohort study of 17 patients demonstrated high accuracy of flow rate averaging 94% between visits, showing reliability. Secondary measures demonstrated therapeutic effects similar to other ITBPs, with reduced oral antispasmodics. This patient achieved excellent control, but Codman’s discontinuation leaves users vulnerable to withdrawal. The constant-flow, non-programmable design, though reliable, limits dosing flexibility and increases withdrawal risk if refills are delayed. In this case, uninterrupted therapy was ensured through early pharmacy coordination, distributor communication, and adjustment of refill schedules to maintain continuous baclofen delivery.

Conclusions:

This case shows legacy management and non-standard Codman pump use in spastic cerebral palsy patients wishing to avoid repeat ITBP surgeries.