• Toru Fukuhara, Tomotaka Tanaka, Yoichiro Namba, and Hideyuki Kuyama.
• Division of Neurosurgery, Neuro-Research Institute for Stroke Care, National Hospital Organization Okayama Medical Center, Okayama, Japan. torufk@ninus.ocn.ne.jp
• Surg Neurol. 2009 Jul 1;72(1):80-2; discussion 82.

BackgroundSeveral catheter problems have been reported as causes of baclofen pump malfunction; however, a tangled catheter has never been described.Case DescriptionA 52-year-old woman with bilateral leg spasticity because of spinal multiple sclerosis underwent baclofen pump implantation, which was subcutaneously placed in the right upper quadrant. She visited for a pump refill 3 months postimplantation with reworsening of her leg spasticity. It was noted that there was more baclofen remaining in the pump than programmed. Abdominal x-ray indicated the kink of the catheter around the pump, and the catheter was explored under local anesthesia. Upon exposure, the catheter was found to be tangled. After the revision of this tangled catheter, the patient's spasticity improved again.ConclusionsAlthough the exact mechanism of this complication is unknown, the friction-compression of the catheter against the iliac bone may be the cause. Implanting the pump away from the bony formation may avoid catheter entanglement.

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