Neurologic sequelae of intraspinal drug delivery systems: results of a survey of american implanters of implantable drug delivery systems.

OBJECTIVES. The development of neurological sequelae subsequent to the placement of intraspinal drug delivery systems is particularly distressing. An attempt was made to determine the extent of this problem in both reported and in heretofore unreported cases. Methods. A survey was mailed to 3269 implanters of intraspinal infusional systems to identify new cases of neurological sequelae of pump Implantation. 519 out of 3269 surveys mailed out responded. Results. There were 488 "no" respondents and 31 "yes" respondents to the question: "did any patient of yours develop neurologic sequelae or granulomatous catheter mass formation after implant of their intraspinal catheters?" 6 new, heretofore unreported cases of granulomatous mass formations at catheter tips were reported. 27 cases of neurological sequelae due to other etiologies were also noted. Also presented in this paper are 4 case reports to augment reader understanding of the problem. Conclusions. The problem of post-implant neurological sequelae is potentially devastating. Increased vigilance for early diagnosis may prevent the development of permanent paralysis. Gadolinium enhanced MRI scanning at the catheter tip is the imaging study of choice for diagnosis. Any patient developing a new area of pain, weakness or rapid escalation in intrathecal drug dose should be thoroughly assessed.