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Thread: syringomyelia and baclofen pump

  1. #1

    syringomyelia and baclofen pump

    Any controindication for the implant of an intrathecal pump in a person with non treated (he doesn't want to go under surgery, his neurological condition is VERY VERY SLOWLY deteriorating) syringomyelia? how will the injected drug be drained if the CSF flow is impaired? Thanks
    Antonio

  2. #2

    Pump and syrinx

    The volume of drug injected with a balofen pump is very small. If the syrinx were drained into the peritoneal or plural cavity, there might be some problems with maintaining drug levels. Many times syrinxes are drained into the dural space, and as long as there are not significant adhesions, the flow of CSF usually is not significantly impaired with a syrinx.

    I is probably safer to not have syrinx shunting in place if a pump is placed due to the risks of infection with both.

    I have not had to deal with this problem specifically with a patient of mine, so I will also consult with the other SCI-Nurses. Stay tuned for more input.

    (KLD)

  3. #3
    Antonio, there is no contraindication to use of the baclofen pump in people with syringomyelia. The pump dosage has to be titrated anyway. In general, average pulsatile CSF flow in the subdural space is downward in the posterior side and upward in the anterior side. In the central canal, according to a neurosurgeon who is an expert on this subject and works in my laboratory, the flow goes up.

    Some reduction in CSF circulation is likely if you have a syrinx. This is because several reports in the last few years suggest that removal of intradural adhesions will eliminate the syringomyelic cyst in as many as 75% of patients. But, I don't think that reduced CSF flow is a contraindication to baclofen pump as long as the catheter is placed below the areas of obstruction. You just have to adjust the dose delivered by the pump. You should work with your doctor to titrate the dose appropriately.

    Wise.

  4. #4

    syringomyelia and the baclofen pump

    I agree with both Dr. Young and KLD that a syrinx in itself is not a contraindication for implant of the intrathecal baclofen pump. However, it could be a constant source of noxious stimulation for your spasms and make it more difficult and challenging to make dosage adjustments. If you do choose to have the syrinx repaired with a shunt your surgeon will need to be cautious about its placement so as not to interfere with the intrathecal catheter. The syrinx repair should ideally take place before the intrathecal pump/catheter placement and/or be carefully coordinated. As the others mentioned discuss the risks and ramifications with a neurosurgeon and your rehab MD before proceeding. Keep us posted. PL

  5. #5
    I just had my syrinx operated on.
    not shunt was placed.
    the post operative MRI shows that the syrinx has subsided in the cervical and the area above injury t6, but not below.
    my spasticity is incredibly high, both in legs and in core (below t6).
    i had expected the surgery to solve - at least partially - the spasticity. It has not.
    My itb pump is currently at 750micrograms with no impact at all. (I used to have enough with 100 1.5 years ago!!)

    My question is: is there any benefit in changing the position of the catheter to above the injury level?
    it could be the at the csf does not flow properly upwards due to the syring from t8 to l2.


    my surgeon seems to think its a good idea...

    do you have an opinion on this?

    Chris

    Quote Originally Posted by SCI-Nurse View Post
    The volume of drug injected with a balofen pump is very small. If the syrinx were drained into the peritoneal or plural cavity, there might be some problems with maintaining drug levels. Many times syrinxes are drained into the dural space, and as long as there are not significant adhesions, the flow of CSF usually is not significantly impaired with a syrinx.

    I is probably safer to not have syrinx shunting in place if a pump is placed due to the risks of infection with both.

    I have not had to deal with this problem specifically with a patient of mine, so I will also consult with the other SCI-Nurses. Stay tuned for more input.

    (KLD)

  6. #6
    Changing the position of the catheter can have an impact on delivery of the baclofen with an intrathecal pump. Use a neurosurgeon who has done this procedure with success. If you are concerned then get a second opinion.

    pbr

  7. #7
    Thanks for that. I Will consult The ns on wednesday And let you Guus know

  8. #8
    @pbr: my neurosurgeon, the only Medtronic specialist in the country, seem to think that moving the catheter from L3-4 where it is now to t4-5 would have less effect on the lower limbs where I have most of my spasticity.
    What is your opinion on this?

    I am a t6. Spasms in legs and in core, very very very very strong, all the way to chest level.
    slight clonus on left leg
    spasms increase when cathing, and when touching skin at and below groin level
    abnormal sweating on right side only between chest and hip

    chris

  9. #9
    No, we are now putting pumps in higher and the ciruclation of the CSF goes downward and it should be the same. And most importantly it will help the spasms in your "core". It doesn't help much above the level of placement. Increase your dose or have flex bolus dosing increase around time of cathing to alleviate the spasms at those times.
    CWO

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