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Intrathecal Pump Implantation

Intrathecal pump implantations are for patients who suffer from various chronic pain conditions and who are no longer achieving optimal pain relief from maximal medical therapy or who experience intolerable side effects from these medications.

Conditions which may be appropriate for intrathecal therapy include complex regional pain syndrome (CRPS)/reflex sympathetic dystrophy(RSD), cancer pain, phantom limb pain, post herpetic neuralgia (shingles), lumbar post-laminectomy syndrome, and peripheral neuropathies.

The spinal cord and the spinal nerves reside in a tissue casing called the dural sac. This dural sac is protected within the bony spinal column. An intrathecal pump is an implanted device that delivers medications via a catheter directly into the spinal fluid housed within the dural sac, also known as the intrathecal space.

The purpose of the pump is to interrupt pain signals that travel through the spinal cord. The spinal cord contains pain receptors; therefore, the direct delivery of medications into this area results in significant pain relief with far lower doses and side effects than by taking similar medications by mouth.

Medications that can be infused through this device include opioids (ex. Morphine), local anesthetics, anti-spastic medications, and other analgesics.  An intrathecal pump cannot be implanted if you have a systemic infection, if you use prescription-strength anti-clotting medications, or if you have allergies to the medication infused.

How It Works

There are two phases to intrathecal pump implantation — a trial version and a permanent version. Those patients who are carefully selected as candidates for intrathecal therapy will first undergo a trial to test their response to temporary intrathecal delivery of medications.

Intrathecal pump trials are performed under live fluoroscopic guidance to ensure the accuracy and safety of this procedure. 

  • You will be asked to lay on your stomach. 
  • Your back will be cleaned with an antiseptic, and a sterile drape will be placed.  
  • Your JLR Center for Pain Medicine physician will inject a local anesthetic to numb the skin.
  • A fine needle will be guided into the dural sac under sterile conditions, and the medication will be injected into the intrathecal space.  
  • If this injection significantly relieves your pain for a brief period of time (6-24 hours), you will be scheduled for permanent implantation of an intrathecal pump.

Permanent intrathecal pump implantation is performed under live fluoroscopic guidance to ensure the accuracy and safety of this procedure. This procedure may be performed by one of our JLR team physicians or by a neurosurgeon. When it is performed by one of our physicians, the intrathecal catheter will be placed percutaneously (through a needle). The catheter will then be tunneled under your skin and connected to a medication reservoir that is implanted under your skin, typically in your abdomen. This pump can then be intermittently accessed via a fine needle to remove old medicine and refill the reservoir with new medication to ensure optimal medication levels remain for infusion.

Risks

Risks of this procedure include failure of therapy, infection, bleeding, and/or allergic reaction. Even less likely risks include paralysis and nerve injury. Your physician carefully uses x-ray guidance and sterile techniques throughout the procedure to significantly reduce these risks. Complications specific to intrathecal pump therapy include catheter disconnection, catheter kinking, and intrathecal granuloma which may require surgical intervention.