Repeated subarachnoid catheter displacement as a complication of spinal infusion using an internal infusion pump

OBJECTIVE: To present and analyze the case of a woman receiving chronic spinal opioid therapy using an implanted infusion pump who experienced repeated displacement of the subarachnoid catheter despite the use of standard techniques for anchoring the catheter. The solution devised to avoid the problem is described. CASE REPORT: A 53-year-old woman was diagnosed with transverse myelitis 10 years earlier and she developed T7-T10 spinal cord atrophy, and pain below the T7 segment. After unsuccessful noninvasive pharmacological treatment, a spinal opioid infusion protocol was begun. On 3 occasions during the course of therapy, despite the use of standard measures for anchoring the system, catheter displacement into the subcutaneous pouch of the pump occurred. After the last such episode, a specially designed technique was used, anchoring the catheter by means of a silicone piece, and the injection of 2.5 mL of fibrin glue in the epidural space. CONCLUSIONS: The application of fibrin glue (Tissucol; Immuno AG, Vienna, Austria) may be considered as an adjuvant for the fixation of subarachnoid catheters used for intraspinal infusions.