Intrathecal pump
Encyclopedia
An intrathecal pump is a medical device
used to deliver very small quantities of medications directly to the spinal fluid of a human being. Medications such as baclofen
, morphine
, or ziconotide may be delivered in this manner to minimize the side effects often associated with the higher dosages commonly found in oral medications of the same type.
People with spastic diplegia
or other forms of spasticity
, or people in intolerable pain and nociception, who cannot tolerate side effects of the higher-dose oral medications of the same medication type, are potential candidates for that medication being administered via an intrathecal pump. In about 5% of patients, the intrathecal baclofen route has no effect on the nervous system.
The intrathecal pump consists of a metal pump
which stores and delivers the medication, and a catheter
which delivers the medication from the pump to the intrathecal
space in the spine where the medication takes effect. Two types of pumps are available: a constant rate pump delivers the medication at a constant rate, and a programmable pump delivers the medication according to a rate determined by a programmable computer program.
The implantable medical device requires a surgical procedure; a surgeon
usually performs a trial intrathecal injection or a temporary intrathecal pump to determine if the medication works to begin with, and thus if a pump is appropriate. A permanent intrathecal pump is then implanted if the patient derives at least 50% improvement in his or her symptoms.
Despite the potential benefits of the intrathecal pump, complications from the implantation are major when they occur, and can happen at any time, even when the initial implantation is successful for several years in a row. Complications from the surgery itself are actually very rare in the present day — infection and excessive bleeding during the surgery, spinal cord injury
during the surgery, or catheter fracture or migration on the operating table do exist as risks, but typically do not happen. Anywhere from soon after the surgery all the way to several years of use of the implanted pump can be the moment when the pump malfunctions or stops working properly. One never knows when something can go wrong with the pump's function. This is a major reason why intrathecal pumps are not recommended when other solutions such as rhizotomy
or stable oral doses of the medication can be used instead.
Medical device
A medical device is a product which is used for medical purposes in patients, in diagnosis, therapy or surgery . Whereas medicinal products achieve their principal action by pharmacological, metabolic or immunological means. Medical devices act by other means like physical, mechanical, thermal,...
used to deliver very small quantities of medications directly to the spinal fluid of a human being. Medications such as baclofen
Baclofen
Baclofen is a derivative of gamma-aminobutyric acid . It is primarily used to treat spasticity and is under investigation for the treatment of alcoholism....
, morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
, or ziconotide may be delivered in this manner to minimize the side effects often associated with the higher dosages commonly found in oral medications of the same type.
People with spastic diplegia
Spastic diplegia
Spastic diplegia, historically known as Little's Disease, is a form of cerebral palsy that is a neuromuscular condition of hypertonia and spasticity in the muscles of the lower extremities of the human body, usually those of the legs, hips and pelvis...
or other forms of spasticity
Spasticity
Spasticity is a feature of altered skeletal muscle performance in muscle tone involving hypertonia, which is also referred to as an unusual "tightness" of muscles...
, or people in intolerable pain and nociception, who cannot tolerate side effects of the higher-dose oral medications of the same medication type, are potential candidates for that medication being administered via an intrathecal pump. In about 5% of patients, the intrathecal baclofen route has no effect on the nervous system.
The intrathecal pump consists of a metal pump
Pump
A pump is a device used to move fluids, such as liquids, gases or slurries.A pump displaces a volume by physical or mechanical action. Pumps fall into three major groups: direct lift, displacement, and gravity pumps...
which stores and delivers the medication, and a catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
which delivers the medication from the pump to the intrathecal
Intrathecal
Intrathecal is an adjective that refers to something introduced into or occurring in the space under the arachnoid membrane of the brain or spinal cord...
space in the spine where the medication takes effect. Two types of pumps are available: a constant rate pump delivers the medication at a constant rate, and a programmable pump delivers the medication according to a rate determined by a programmable computer program.
The implantable medical device requires a surgical procedure; a surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
usually performs a trial intrathecal injection or a temporary intrathecal pump to determine if the medication works to begin with, and thus if a pump is appropriate. A permanent intrathecal pump is then implanted if the patient derives at least 50% improvement in his or her symptoms.
Despite the potential benefits of the intrathecal pump, complications from the implantation are major when they occur, and can happen at any time, even when the initial implantation is successful for several years in a row. Complications from the surgery itself are actually very rare in the present day — infection and excessive bleeding during the surgery, spinal cord injury
Spinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
during the surgery, or catheter fracture or migration on the operating table do exist as risks, but typically do not happen. Anywhere from soon after the surgery all the way to several years of use of the implanted pump can be the moment when the pump malfunctions or stops working properly. One never knows when something can go wrong with the pump's function. This is a major reason why intrathecal pumps are not recommended when other solutions such as rhizotomy
Rhizotomy
A rhizotomy is a term chiefly referring to a neurosurgical procedure that selectively severs problematic nerve roots in the spinal cord, most often to relieve the symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy...
or stable oral doses of the medication can be used instead.