VP shunt + IT pump

[Preganglionic]

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I have a patient with spina bifida, hydrocephalus s/p VPS, and chronic LBP inquiring about ITP. Any one have any experience with this? I did find some concerning literature on patients with baclofen pumps but nothing on pain pumps.

Childs Nerv Syst. 2007 Jul;23(7):733-8. Epub 2007 Mar 16.
Interaction of ventriculoperitoneal shunt and baclofen pump.

Fulkerson DH, Boaz JC, Luerssen TG.
Source

Pediatric Neurosurgery Service, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive, Room 1134, Indianapolis, IN 46202, USA. [email protected]

Abstract

OBJECTIVE:

The authors present three cases of children with shunted hydrocephalus and intrathecal delivery of baclofen via an implanted pump. Each case illustrates a potential interaction of these devices.
MATERIALS AND METHODS:

A review of the pertinent charts, operative notes, and discharge summaries was performed, along with examination of the pertinent literature.
CONCLUSION:

The first case illustrates that a change in the pharmacology or effect of intrathecal baclofen may be caused by a failure of a shunt affecting cerebrospinal fluid clearance. The second case illustrates that patients can have ventricular changes with any procedure that accesses the thecal space, even with a functioning shunt. The third case illustrates that ensuring that a patient's shunt is functional before implantation of a baclofen pump is imperative. As the potential pool of patients with both shunted hydrocephalus and need for intrathecal baclofen grows, clinicians should be aware of potential serious interactions.

 

[painstop]

That sounds like an interesting case that I wouldn't want to touch with a ten foot pole...whatever you do I applaud you. If it's truly axial LBP and assuming you've already performed diagnostic MBBs, etc. without success and the pt's insurance is willing to do so you could try a workaround like a SCS trial (place the leads at T8-10 although it is often still not obtainable; consider a tripole array) (could also consider peripheral nerve stim of the lower back although insurance would likely deny). Let us know what you end up doing.