Article

Intrathecal Baclofen (ITB) therapy is a common treatment used to reduce
spasticity due to neurologic disorders and injuries. A variety of factors can
increase the difficulty of ITB pump refill. Excess subcutaneous fat overlying the
pump, spasticity, suboptimal positioning, pump rotation or inversion, and scar
formation over the reservoir fill port can create challenges during pump refill.
As a result, multiple unsuccessful attempts at accessing the reservoir fill port
can be painful and increase the risk of infection, particularly when repeat skin
puncture is required. Blind attempts to refill a pump in challenging cases may
also result in subcutaneous injection or pocket fill, resulting in a potentially
fatal baclofen withdrawal syndrome. We describe 3 successful ITB pump refills in
technically challenging cases when using ultrasound guidance. This represents an
innovative approach to using ultrasound guidance to facilitate ITB refill in
adults with intractable spasticity. We present these new clinical data with a
literature review of potential complications related to inaccurate pump refill
procedures and discuss the utility of ultrasound guidance for preventing such
adverse events.

Langue : ANGLAIS