Hyperbaric trauma of an intrathecal baclofen pump secondary to scuba diving: About one case

Abstract

Spasticity is a frequent consequence to a cerebral or spinal cord damage. Therapeutic strategies depend on the repercussions on patients’ daily activities and the fact that is a focal or spread spasticity. Intrathecal Baclofen pump (ITB Pump) implantation come with a frequent medical follow-up, and a specific patient's education as some complications may occur. Case report. A 60-year-old male patient was implanted with ITB Pump 15 years after a traumatic spinal cord injury of level T11 ASIA-A and Frankel-A. He is independent in his daily life and rather active. During his follow-up, 2 back-to-back refill procedures were limited to 14 mL of drug out of a usual 20 mL reservoir. The patient had gone back to scuba diving 4 months before without medical awareness or specific precautions, sometimes even below 10 meters. This induced the bottom shield of the pump to collapse under the pressure and repeated hyperbaric exposures. X-Rays prove the permanent mechanical deformation of the device. The ITB pump continues to work normally. The risks of hyperbaric exposure on the ITB pumps are described by the device company. A pressure higher than 2.0 ATA (hyperbaric chambers or dive below 10 meters) may have effects on the drug delivery and/or on the device itself. It can vary from small withdrawal symptoms to fatal drug underdose. Despite the potential permanent deformation, the other side effects should disappear when returning to normal pressure. Doctors and patients must be aware and talk about physical activities as well as other daily life situations as more and more young patients are under ITB pump. Because some risks are specific to sports that are not so rare as we might think.