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  4. Decompression for lumbar spinal stenosis at the intrathecal catheter insertion site during intrathecal baclofen therapy: a case report

Decompression for lumbar spinal stenosis at the intrathecal catheter insertion site during intrathecal baclofen therapy: a case report

Journal of Medical Case Reports, 2023 · DOI: https://doi.org/10.1186/s13256-023-03959-1 · Published: May 17, 2023

NeurologySurgerySpinal Disorders

Simple Explanation

This case report describes a surgical procedure performed on a 61-year-old man with lumbar spinal stenosis who was already undergoing intrathecal baclofen therapy for spasticity. The surgery involved decompression of the lumbar spinal stenosis at the site where the intrathecal catheter was inserted. The surgeons took precautions to avoid damaging the intrathecal catheter during the decompression surgery, and the patient experienced improvement in lumbar spinal stenosis symptoms while continuing to receive effective spasticity management from the intrathecal baclofen therapy.

Study Duration
Not specified
Participants
61-year-old Japanese man
Evidence Level
Level 4: Case Report

Key Findings

  • 1
    Decompression surgery for lumbar spinal stenosis can be safely performed at the intrathecal catheter insertion site in patients undergoing intrathecal baclofen therapy.
  • 2
    The intrathecal catheter does not necessarily need to be removed or replaced during decompression surgery for lumbar spinal stenosis.
  • 3
    Careful surgical technique is essential to avoid damaging the intrathecal catheter or spinal cord during decompression surgery.

Research Summary

The case report describes a 61-year-old man with lumbar spinal stenosis who underwent decompression surgery at the intrathecal catheter insertion site during intrathecal baclofen therapy. The yellow ligament was removed by partial resection of the lamina under a microscope to avoid damage to the intrathecal catheter. Postoperatively, lumbar spinal stenosis symptoms improved, and spasticity remained well controlled with intrathecal baclofen therapy.

Practical Implications

Surgical Planning

Surgeons should be aware of the potential need to replace the intrathecal catheter during surgery and prepare accordingly.

Technical Considerations

Meticulous surgical technique, including the use of a microscope and nerve root retractors, is crucial to protect the intrathecal catheter and spinal cord.

Postoperative Management

Close monitoring for ITB withdrawal syndrome is necessary to prevent interruption of baclofen delivery.

Study Limitations

  • 1
    Single case report limits generalizability.
  • 2
    Lack of detailed long-term follow-up.
  • 3
    Potential for bias in reporting outcomes.

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