Late-onset Kinking of the Ascenda Catheter following Intrathecal Baclofen Pump Implantation: A Case Report

<p>Intrathecal baclofen therapy has become a widely adopted and effective surgical treatment for severe spasticity. However, it is known to carry a range of potential complications. We report a case of catheter kinking that occurred during long-term follow-up following initial intrathecal baclofen pump implantation using an Ascenda catheter. The patient was diagnosed with cerebral palsy in infancy, and spasticity in all 4 limbs gradually progressed. At 5 years of age, an intrathecal baclofen pump was implanted using an Ascenda catheter, which improved spasticity. However, at 14 years of age, she began to exhibit gradual worsening of spasticity. The percentage of drug delivery deviation was 65.50% at 9 years and 5 months after the initial surgery. Radiography showed that the tip of the Ascenda catheter had migrated caudally. In addition, scoliosis progression over the past 4 years was noted. Three-dimensional computed tomography revealed catheter kinking proximal to the anchor. Kinking of the Ascenda catheter was determined to be the cause of underdelivery of the drug and the subsequent worsening of spasticity. Catheter revision surgery was performed. The kinked segment of the previous catheter was removed and cut, and the newly inserted catheter was connected. Postoperatively, spasticity rapidly improved. Patients undergoing intrathecal baclofen therapy, especially those with cerebral palsy and scoliosis, should be clinically monitored for worsening spasticity and significant changes in drug delivery deviation, even when using Ascenda catheters. Rapid worsening of spasticity or marked drug delivery deviation changes should raise suspicion of catheter-related complications. Progression of scoliosis in patients with intrathecal baclofen may lead to catheter kinking, warranting ongoing close monitoring.</p>