Bassani Luigi, Harter David H
Department of Neurosurgery, New York University Langone Medical Center, New York, New York, USA.
J Neurosurg Pediatr. 2012 Jan;9(1):93-8. doi: 10.3171/2011.10.PEDS11168.
Techniques for the placement of intrathecal baclofen (ITB) systems have been described in detail, with special consideration given to complications from hardware placement. Risks including catheter kinking and migration, hardware erosion through the skin, and lumbar CSF leak are elevated given the often-low body mass index and poor nutritional status of this patient population. The bulk of a spinal catheter and fascial connector within the lumbar wound may increase the potential for the aforementioned risks, leading to potential risks for wound infection and breakdown. The authors' experience has led them to develop a novel method of paraspinal subfascial lumbar catheter placement to address these risks. The authors describe a novel lumbar intrathecal catheter placement technique as part of the ITB system.
All patients undergoing placement of an ITB system by the senior author at New York University Langone Medical Center between July 2010 and March 2011 underwent paraspinal subfascial lumbar catheter placement. Patients were followed-up by the surgeon 2 weeks after implantation and followed up and managed by their physiatrist thereafter, for an average of 5 months (range 0.5-9 months). Results Of the 20 patients who underwent this method of intrathecal catheter placement, none developed any hardware erosion, catheter migration, or CSF leak. One patient developed an abdominal wound infection 3 weeks after implantation, necessitating pump removal.
In this initial short-term experience, subfascial placement of the lumbar spine intrathecal catheter may be an improvement over the traditional method of catheter placement. There is reduced risk of catheter migration or kinking, hardware erosion, CSF leak, and decreased operative time, all yielding a decreased reoperation rate in this vulnerable population.
鞘内注射巴氯芬（ITB）系统的放置技术已被详细描述，尤其考虑了硬件放置引起的并发症。鉴于该患者群体通常体重指数较低且营养状况较差，包括导管扭结和移位、硬件经皮肤侵蚀以及腰椎脑脊液漏等风险有所增加。腰椎伤口内的脊柱导管和筋膜连接器体积较大，可能会增加上述风险，导致伤口感染和破裂的潜在风险。作者的经验促使他们开发了一种新型的椎旁筋膜下腰椎导管放置方法来应对这些风险。作者将一种新型的腰椎鞘内导管放置技术描述为ITB系统的一部分。
2010年7月至2011年3月期间，纽约大学朗格尼医学中心的资深作者为所有接受ITB系统放置的患者进行了椎旁筋膜下腰椎导管放置。患者在植入后2周由外科医生进行随访，此后由其物理治疗师进行随访和管理，平均随访5个月（范围0.5 - 9个月）。结果：在接受这种鞘内导管放置方法的20例患者中，无一例发生硬件侵蚀、导管移位或脑脊液漏。1例患者在植入后3周发生腹部伤口感染，需要移除泵。
在这一初步的短期经验中，腰椎鞘内导管的筋膜下放置可能是对传统导管放置方法的一种改进。导管移位或扭结、硬件侵蚀、脑脊液漏的风险降低，手术时间缩短，所有这些都降低了这一脆弱人群的再次手术率。
