Ultrasound-Guided Intrathecal Baclofen Pump Refilling Method for Management of Spasticity in a Complex Clinical Case

Abstract

Intrathecal baclofen (ITB) administration is a common method in managing spasticity. The location of the reservoir fill port (RFP) is identified manually in most cases. However, it can be difficult due to a variety of factors, such as the formation of excess subcutaneous cellular tissue and scar formation overlying the RFP and rotation or inversion of the pump. Consequently, multiple failed attempts accessing the reservoir increases pain and risk of fatal complications (e.g., infection and withdrawal syndrome from pocket filling). We describe a successful ultrasound-guided pump refilling case after multiple failed attempts by the conventional method. This groundbreaking instrument assists this minimally invasive procedure while limiting iatrogenic injury in the treatment of spasticity. The presentation of this case shows the utility of ultrasound as an important tool to guide the procedure and prevent adverse events in a spasticity management consult.

Efficacy of ultrasound-guided botulinum toxin type A in shoulder pain: a meta-analysis on randomized controlled trials

“…Because of the small sample size of subgroup 2, the assessment of e cacy may be affected. Younger patients bene t less time relative to older patients when treated with BoNT-A injections [49]. Given that the mean age of studies included in subgroup 1 was greater than that of subgroup 2, older age may have led to a greater improvement in abduction in subgroup 1 than in subgroup 2.…”