Assessment of intrathecal baclofen pump malfunction: A new algorithm including nuclear medicine investigation.

OPINION/FEEDBACK: Intrathecal baclofen is now an admitted treatment of generalized and disabling spasticity. Technical incidents of the device remain frequent, mainly due to catheter problems. Consequences can be abrupt with life-threatening withdrawal syndrome or progressive with spasticity reappearance. In case of progressive withdrawal syndrome, the assessment process has to be meticulous to find the cause of inefficiency and to avoid useless revision surgery. This assessment includes medical examination, radiographs, intrathecal baclofen bolus, after what, if no conclusion can be drawn, a more invasive imaging exam has to be performed. Radio-opaque dye study by injecting contrast through the lateral access port is the assessment the most used, but it has some drawbacks as the difficulty to access to the lateral access port. In our experience nuclear medicine assessment with Indium scintigraphy coupled with computed tomography is underused and should be an alternative to other imaging exam. Using our experience, we want to discuss a proposition of diagnostic algorithm for intrathecal baclofen pump inefficiency adding nuclear imaging exam adapted from already existing algorithms.