Intrathecal drug delivery devices (IDDDs) are a mainstay in the treatment of spasticity and refractory pain. While these devices have been shown to greatly improve the quality of life for patients, they also have a high perioperative complication and failure rate. A major complication of IDDD implantation is infection. The current standard of care in the treatment of IDDD infection necessitates that the pump be explanted and the infection treated prior to implantation of a new IDDD. This process leads to long hospital stays, interruptions in optimal medical management, and a high risk for dangerous drug withdrawals. The authors describe a technique that allows for the explantation of the infected pump and implantation of a new pump concurrently, which they have named the “Turner Switch” technique in honor of its inventor.
The authors conducted a retrospective analysis of cases of infected IDDDs in which patients underwent simultaneous explantation of the infected pump and implantation of a new pump. Demographics and clinical data were collected.
Data from a total of 17 patients (11 male, 6 female) who underwent simultaneous IDDD explantation and implantation to treat infections were analyzed from a 3-year period. No patients experienced infection of the newly implanted pump or catheter. Of the 17 patients, 14 (82.4%) had baclofen pumps to treat spasticity and 3 (17.6%) had fentanyl pumps to treat chronic pain. The median hospital stay was 7 days, with 16 of 17 (94.1%) patients able to be discharged home or to a facility with a level of care similar to their preoperative care. All patients ultimately experienced complete resolution of their initial infections. Five patients (29.4%) required a return to the operating room within the next 5 months (for repair of a CSF leak in 2 cases, for treatment of infection at the old pump site in 2 cases, and for treatment of a CSF leak compounded with infection in 1 case). No patient experienced infection of the newly implanted pump or catheter.
IDDD infections represent a large portion of morbidity associated with these devices. The current standard of care for deep pump infections requires pump explantation and a course of antibiotics prior to reimplantation of the IDDD. The authors demonstrate the effectiveness of a procedure involving simultaneous explantation of an infected pump and implantation of a new pump on the contralateral side in the treatment of IDDD infections.
ABBREVIATIONSCP = cerebral palsy; ICU = intensive care unit; IDDD = intrathecal drug delivery device; OR = operating room; SCI = spinal cord injury.
AlbrightALAwaadYMuhonenMBoydstonWRGilmartinRKrachLE: Performance and complications associated with the synchromed 10-ml infusion pump for intrathecal baclofen administration in children. J Neurosurg101 (1 Suppl):64–682004
BealBR: Intrathecal drug delivery system infections (meningitis, encephalitis, pump pocket contaminants) in AnitescuMBenzonHT and WallaceMS (eds): Challenging Cases and Complication Management in Pain Medicine. Cham, Switzerland: Springer International Publishing2018 pp 219–223
EngleMPVinhBPHarunNKoyyalaguntaD: Infectious complications related to intrathecal drug delivery system and spinal cord stimulator system implantations at a comprehensive cancer pain center. Pain Physician16:251–2572013
MalheiroLGomesABarbosaPSantosLSarmentoA: Infectious complications of intrathecal drug administration systems for spasticity and chronic pain: 145 patients from a tertiary care center. Neuromodulation18:421–4272015
SayedDMonroeFOrrWNPhadnisMKhanTWBraunE: Retrospective analysis of intrathecal drug delivery: outcomes, efficacy, and risk for cancer-related pain at a high volume academic medical center. Neuromodulation21:660–6642018