Abstract
ObjectivesIntrathecal drug administration using an implanted pump system is well established in intractable spasticity and pain. However, despite continuous advancements in manufacturing technology, adverse events related to the pump and catheter still occur. Most of them, such as migration, damage, disconnection and occlusion, are related to the spinal catheter. The aim of this overview is to update radiologists on how plain radiography of the implanted delivery system for intrathecal drug administration should be interpreted and to increase awareness for the need of urgent and timely multidisciplinary troubleshooting.MethodsPlain radiographic images of patients treated with intrathecal drug administration using an implantable drug delivery system were analysed in a multidisciplinary setting at our (university) referral centre for complications in intrathecal drug administration.ResultsExamples of catheter-related adverse events are described and a proposal is made for stepwise interpretation of standard plain radiographic images.ConclusionsPlain radiological images are the mainstay for the diagnosis of catheter-related adverse events in intrathecal drug delivery. Radiologists play an important role in an early diagnosis. An awareness of abnormal radiological findings seems important to avoid a life-threatening withdrawal syndrome.Teaching points• Untimely cessation of intrathecal drug delivery can lead to a life-threatening withdrawal syndrome.• Initially mild symptoms can lead to an exacerbation of a withdrawal syndrome.• Most intrathecal catheter-related problems are visible on plain radiography.• Common causes of catheter problems are migration, lacerations, occlusion and disconnection.• Knowledge on implanted intrathecal catheters is crucial for interpretation of plain radiography.
Highlights
For over 30 years intrathecal drug delivery systems have been successfully applied in thousands of patients for the management of spasticity [1, 2] and dystonia [3], and for chronic pain [4, 5]
There is general consensus that intrathecal therapy should be reserved for patients who have an insufficient response to more conservative therapies and/or for patients who experience serious side effects [7]
During continuous intrathecal drug delivery, the prescribed medication is administered through an intrathecal catheter, connected with an
Summary
For over 30 years intrathecal drug delivery systems have been successfully applied in thousands of patients for the management of spasticity [1, 2] and dystonia (both intrathecal baclofen) [3], and for chronic pain (intrathecal analgesic drugs) [4, 5]. There is general consensus that intrathecal therapy should be reserved for patients who have an insufficient response to more conservative therapies and/or for patients who experience serious side effects [7]. Despite generally favourable and safe outcomes [8, 9] and continuous advancements in manufacturing technology, pump and catheter-related adverse events still occur [10]. Insights Imaging (2017) 8:499–511 exposure to adverse events remains a problem. Recognition of complications and their prompt management is needed
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