Intrathecal Pumps

Abstract

Summary: Direct neuroaxis drug delivery has expanded the physician's armamentarium to provide treatment options to those who have failed more conservative interventions. Starting from Bier's 'cocainization of the spinal cord' in 1898, direct nervous system pharmacy delivery has long been recognized as an effective means to treat pain. Intrathecal pump systems are now commonplace in the management of numerous pain states, as well as of neuromuscular sequelae of central nervous system injury. There has been much advancement in the physiologic and pharmacologic understanding of direct neuromodulation, providing a growing number of treatment options depending on the specific disease state. As well, surgical techniques and catheter systems have undergone refinements providing improved long-term safety and efficacy. We present a review of the historical evolution to current intrathecal therapies, as well as a dialog regarding patient selection, drug options, and side effects. Also, included is a discussion of surgical techniques, current delivery options and complications concerning pump placement.

A Review of the Biocompatibility of Implantable Devices: Current Challenges to Overcome Foreign Body Response

“…Of particular significance is the progress that has been made in the areas of implantable devices and drug/device combination products, such as drug-eluting stents, [1][2][3][4][5] artificial organs, 6-9 biosensors, 10,11 catheters, 12 scaffolds for tissue engineering, [13][14][15] and heart valves. 16,17 Nevertheless, the biocompatibility of implantable devices remains a critical issue in limiting device longevity and functionality, particularly in the case of biosensors.…”

Antisense correction of SMN2 splicing in the CNS rescues necrosis in a type III SMA mouse model

“…Although the inability of ASOs to cross the BBB limits the utility of systemic administration, well-established implantable catheters and pump technology can overcome this obstacle. Intrathecal pumps have been used clinically to deliver drugs to the spinal cord of patients with debilitating chronic pain or severe spasticity (Belverud et al 2008), and should be suitable for ASO delivery. In addition, our experiments in embryonic mice demonstrate that a bolus injection is also effective.…”

Spinal Cord Compression in Maroteaux-Lamy Syndrome: Case Report and Review of the Literature with Effects of Enzyme Replacement Therapy

“…Several IT drug delivery devices are marketed for these applications, with the benefits and inherent complications generally well understood also in children. New surgical techniques and catheter systems provide improved long-term safety and efficacy [23,24,25]. Unfortunately, long-term observation of IT delivery of baclofen in children has shown a large number of complications after placement of IT pump/catheters [26].…”