A 41 year-old female with multiple sclerosis complicated by severe spasticity managed by intrathecal baclofen underwent pump revision due to battery exhaustion. The day after surgery, the patient presented to the ER with symptoms of uncontrolled spasticity and perceived baclofen withdrawal. Fifty mcg of baclofen was bolused without any effect. Her baclofen pump was evaluated using proper pump evaluation protocol including catheter dye study, electronic analysis and reprogramming. Normal function was based on easy CSF aspiration via the catheter access port, easy injection of contrast and appropriate reservoir volume. After optimizing the angle of view and directly visualizing the catheter tip, contrast could not be seen entering the intrathecal space using normal CINE mode fluoroscopy; however, the pump was assumed to be functioning. The patient was re-evaluated in 1 week intervals with no change noted despite 15% dose increases twice. Repeat pump evaluation included 1) a rotor study and 2) the CINE mode of digital subtraction method fluoroscopy displaying real-time injection of contrast with simultaneous CSF spread from the catheter tip. Only by using the digital subtraction method were we able to conclusively provide evidence of contrast spread within the intrathecal space. A literature search was done and intrathecal baclofen pump experts were contacted. To the best of our knowledge, this innovative technique of digital subtraction under CINE mode to verify catheter tip has not been used to verify proper placement of an intrathecal baclofen pump catheter. Normally, confirmation of proper catheter function and position requires verification of contrast spread from the intrathecal catheter via CT myelography. Therefore, digital subtraction CINE mode fluoroscopy represents an innovative method to verify function and position during work up of potential intrathecal pump dysfunction. Compared to CT myelography patient radiation exposure is less, results are instantaneous and assessments can be made in real time. A 41 year-old female with multiple sclerosis complicated by severe spasticity managed by intrathecal baclofen underwent pump revision due to battery exhaustion. The day after surgery, the patient presented to the ER with symptoms of uncontrolled spasticity and perceived baclofen withdrawal. Fifty mcg of baclofen was bolused without any effect. Her baclofen pump was evaluated using proper pump evaluation protocol including catheter dye study, electronic analysis and reprogramming. Normal function was based on easy CSF aspiration via the catheter access port, easy injection of contrast and appropriate reservoir volume. After optimizing the angle of view and directly visualizing the catheter tip, contrast could not be seen entering the intrathecal space using normal CINE mode fluoroscopy; however, the pump was assumed to be functioning. The patient was re-evaluated in 1 week intervals with no change noted despite 15% dose increases twice. Repeat pump evaluation included 1) a rotor study and 2) the CINE mode of digital subtraction method fluoroscopy displaying real-time injection of contrast with simultaneous CSF spread from the catheter tip. Only by using the digital subtraction method were we able to conclusively provide evidence of contrast spread within the intrathecal space. A literature search was done and intrathecal baclofen pump experts were contacted. To the best of our knowledge, this innovative technique of digital subtraction under CINE mode to verify catheter tip has not been used to verify proper placement of an intrathecal baclofen pump catheter. Normally, confirmation of proper catheter function and position requires verification of contrast spread from the intrathecal catheter via CT myelography. Therefore, digital subtraction CINE mode fluoroscopy represents an innovative method to verify function and position during work up of potential intrathecal pump dysfunction. Compared to CT myelography patient radiation exposure is less, results are instantaneous and assessments can be made in real time.