Intrathecal Pump Salvage Using Negative Pressure Instill Therapy

Intrathecal pumps (IP) have a 5% risk of becoming infected.  Of that patient population, 57-80% have infection at the pump pocket site (Rathmell, Lake & Ramundo, 2006 ). Traditional conservative management includes systemic antibiotics, surgical drainage, and topical dressings.  However in most cases pump removal is recommended (Rathmell et al., 2006). Through innovative practice four patients have had successful outcomes using a new approach to IP salvage.  

Patient history included signs and symptoms of local soft tissue infection and no constitutional symptoms or leukocytosis.  Initial therapy included Negative Pressure Wound Instill Therapy (NPWIT) with topical antimicrobial solution. All patients received therapy for a minimum of 23 hours prior to initial reconstructive event. Patients were taken to the operating room for debridement of the IP pocket with washout. If the device was relatively clean with no significant inflammatory symptoms, the patients were reconstructed with myocuteaneous flap closure. Only one patient required additional NPWIT therapy and a second surgical intervention for closure related to the IP pocket being grossly contaminated.

Case #1: 70 year old, Caucasian female using Baclofen IP for significant back pain and leg spasms.

Case #2: 31 year old, Caucasian female using Baclofen IP for treatment of right leg paresis and chronic leg spasticity.

Case #3: 47 year old, Caucasian female using a Morphine/bupivacaine IP for treatment of chronic back pain.

Case #4: 31 year old, Caucasian male using Baclofen IP for spasticity.

Pump pocket is the most common site for infection for IP patients. Using an innovative approach to instill antimicrobial solution to the pump pocket site in conjunction with standard of care, patients experience positive outcomes by maintaining their current IP system.