Intrathecal baclofen pump (ITB)

Overview

A baclofen pump is a surgically implanted device that delivers baclofen, a medication, directly to the spinal canal, the fluid-filled space between your spinal cord and vertebrae. This pump consists of a round metallic disc, about 1 inch wide and 3 inches in diameter, and a thin, flexible catheter. The catheter transports the medication from the pump to the spinal fluid, ensuring a continuous delivery of the medication.

The device is implanted under the skin of your abdomen by a surgeon. Inside the pump, there is a battery, a medication reservoir, and a microprocessor. Your healthcare provider uses a small computer and a wand placed over the device to program the pump, setting a schedule for medication delivery. Periodically, the medication reservoir is refilled by inserting a needle into the pump and injecting the medication.

This system, known as intrathecal baclofen therapy (ITB), allows for precise and controlled medication management. The programming ensures that you receive the correct dosage at the appropriate times, helping to manage your condition effectively.

Reasons for undergoing the procedure

A baclofen pump can assist in managing spasticity resulting from various conditions affecting the brain or spinal cord, such as:

• Multiple sclerosis.
• Spinal cord injury.
• Cerebral palsy.
• Traumatic brain injury.
• Stroke

If you experience severe spasticity that oral medications do not effectively help, your healthcare provider might suggest considering a baclofen pump. They may refer you for a consultation to determine if this treatment option could be suitable for you.

Risk

After surgical implantation of the baclofen pump under anesthesia may cause possible risk that includes:

• Infection at the incision site.
• Bleeding.
• Bruising.
• Leaking of spinal fluid.

The primary side effect commonly associated with a baclofen pump is increased weakness. Adjusting the baclofen dose from the pump can often improve this symptom.

Complications specific to the pump and catheter are uncommon but may include:

• Baclofen overdose.
• Baclofen withdrawal symptoms.
• Displacement or blockage of the catheter.
• Mechanical failure or malfunction of the pump.
• Skin breakdown leading to exposure of the pump or catheter.

Severe complications are rare, although there are instances where they can pose a risk to life. In the majority of cases, prompt medical intervention can reverse these issues.

Baclofen withdrawal can be life-threatening in some cases. It’s essential to consult your healthcare provider on maintaining your pump to prevent these adverse effects. If you suspect baclofen withdrawal, seek immediate medical attention.

Procedure

Baclofen pump surgery involves implanting a device permanently in your body. This device administers baclofen medication directly into the spinal fluid.

Typically, the baclofen pump is placed beneath the skin in your abdomen near your belly button, which is the most common location. Your surgeon will assess factors such as your age, body composition, and overall health to determine the optimal placement for the pump.

On the day of surgery, you will be given general anesthesia to ensure you are asleep and free from pain. During the procedure:

• A small incision will be made in your skin to implant the pump in your abdomen.
• A catheter, or tube, will be connected from the pump to the spinal fluid in your spinal column, requiring a small incision in your lower back to place the catheter tip into your spine.
• The pump will be filled with baclofen.
• Using a computer, the pump will be programmed to deliver a precise dose of baclofen continuously throughout the day.

The procedure typically lasts up to two hours. Following surgery, you will remain in the hospital for a brief period. Depending on your condition, your surgeon may suggest inpatient rehabilitation to assist adjusting to the pump before you are discharged home.

The baclofen pump requires regular refilling, typically every one to six months, performed by a qualified healthcare provider. This involves inserting a needle through your skin into a refill port on the pump. While some refills may be manageable at home, regular follow-up appointments with a provider are essential, occurring one to two times per year, to monitor and ensure the effectiveness of the therapy.

Your healthcare provider can modify the baclofen dosage during any scheduled visit. It’s important to attend your pump refill appointments promptly to avoid the risk of experiencing baclofen withdrawal.

The pump battery needs to be replaced when its life is almost up, usually without the need to replace the catheter. It might be essential to replace or realign the catheter surgically if issues occur with either the baclofen pump or the catheter.

Your healthcare provider will provide thorough education on the device, ensuring you understand its operation and maintenance requirements. If you suspect any malfunction or irregularity with the pump, seek medical attention immediately.

Outcome

Typically, the average recovery period following baclofen pump surgery ranges from six to eight weeks. Your surgeon will provide a more tailored timeframe based on your individual circumstances.

The following advantages of intrathecal baclofen pump includes:

• Effectively manages spasticity associated with various brain and spinal cord conditions.
• Provides continuous medication delivery.
• Associated with fewer side effects compared to oral baclofen.
• Offers the flexibility to program different doses at different times of the day to suit individual needs.
• Both the pump and the catheter can be surgically removed if necessary.

Following surgery, it’s important to refrain from strenuous physical activities until you receive clearance from your healthcare provider and to prioritize rest. You may be advised to wear an abdominal binder for several weeks post-surgery. Hospital stay following the implant procedure is typically a few days, and rehabilitation may be recommended.

A baclofen pump battery generally lasts around six to seven years, although this duration can vary. Your provider will estimate the battery’s lifespan based on the pump’s information.

You will require another surgery to replace the pump before the battery reaches the end of its lifespan. This procedure is typically quicker than the initial placement surgery because the catheter is already in position. In many instances, you can expect to return home the same day.

Seek any medical attention if you experienced any of the following indications:

• Changes in skin color or swelling around the pump or in your back.
• Fever.
• Fluid draining from the incisions.
• Pain or discomfort.

Seek immediate medical attention if you have the following:

• Symptoms of withdrawal such as itchiness, sweating, stiffness of the muscles or spasms, low fever, and dizziness or lightheaded.
• Symptoms of overdose may include drowsiness, weakness, difficulty breathing, low body temperature, seizures, and loss of consciousness.