Spinal Pain Management

Intrathecal Pump Placement

An intrathecal pump is a device used for the treatment of chronic spinal pain, which is unresponsive to medical or surgical therapy. One of the most common indications is failed back surgery. In failed back surgery, the patient’s pain returns or is not alleviated by surgery. Another indication is failed spinal stimulator. In the latter, a spinal cord stimulator has been unsuccessful in treating the patient’s pain.

An intrathecal pump has two parts, a catheter and a drug pump. The catheter is a small tube placed via a small needle into the intrathecal space of the spine. The intrathecal space is a space where the spinal cord lies, bathed in cerebrospinal fluid. The pump is a metal device containing a reservoir, which pumps a drug from the reservoir to the catheter.

An intrathecal pump works by infusing anesthetic drug directly into the spine. This is different from orally taking drugs in that the drugs are administered directly to the site of pain reception, the spinal cord. Because the drugs are administered directly to the spinal cord, patients require a much smaller drug dose and there are fewer drug related side effects.

Placement of an intrathecal pump involves a trial, and if successful, permanent implantation. In the trial, the catheter is placed in the spinal intrathecal space via a small needle placed on the back. Using x-ray guidance, the catheter is advanced to the desired position along the spine. The catheter is then attached to the pump, usually worn on a belt pouch. The procedure is performed under sedation and with local anesthetic. If the trial results in significant pain relief, the pump is permanently implanted.

If the pump trial is successful, an intrathecal is permanently implanted. This procedure is again performed under local anesthesia and sedation. Instead of exiting the skin, the catheter is tunneled under the skin through a small incision in the back to a incision made near the flank. A pouch is created in that second incision. The pump is inserted into the pouch and the catheter is attached to the pump. The incision is then closed with sutures.