Use of O-arm to place an intrathecal catheter through a bony fusion mass: case report.

Background: Intrathecal baclofen (ITB) delivery is an FDA-approved indication for patients with intractable spasticity. Often, implantation in these patients can be considerably challenging, especially if previous surgical fusion involves the procedure access location.

Case report:  We present the case of a 27-year-old female with T2 American Spinal Injury Association (ASIA) A spinal cord injury (SCI) and chronic spastic dystonia. She was maximized on oral medications without satisfactory control of her painful muscle spasms and was a candidate for ITB trial, which ultimately failed due to the difficulty of accessing the spinal canal due to extensive pseudoarthrosis secondary to thoracic to lumbar fusion. A decision was made to directly implant the pump in the operative room using O-arm-aided neuronavigation to guide catheter access at L5-S1. Currently, at 22 months of follow-up post-pump implant, ITB delivery has led to persistent improvements in her spastic dystonia and many aspects of quality of life.

Discussion:  The current case indicates that a multidisciplinary approach when considering surgical treatments for medication-refractory spasticity may help expand the indications to large numbers of patients with postsurgical spine abnormalities.