• N Roche, A Schnitzler, F Genêt, and D Ben Smail.
• Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, APHP, faculté de médecine Paris Ile-de-France Ouest, université de Versailles-Saint-Quentin, 104, boulevard R.-Poincaré, 92380 Garches, France. roche.nicolas@rpc.aphp.fr
• Ann Readapt Med Phys. 2006 Jun 1;49(5):248-51.

IntroductionIntrathecally delivered baclofen has been used as a treatment for severe spasticity since 1984. After a successful intrathecal baclofen trial, a programmable drug delivery system was implanted. Few early complications such as infection or hematoma are observed after this surgery.ObjectiveTo describe an unusual and unknown complication of intrathecal baclofen therapy.MethodWe report 2 cases of complications of intrathecal baclofen therapy, radiculalgy, that appeared early after pump implantation. The clinical symptoms and computed tomography (CT) results are described.ResultsThe first patient described pain, which evoked left S1 radiculopathic features. The second had left L5 radiculopathic involvement. The mean pain level was estimated on a 10-point visual analog scale as 7.5 (range 4-9). Lumbar CT scan showed a conflict between the symptomatic root and the catheter and eliminated other causes of the symptoms. Treatment with analgesic drugs was successful in 1 patient. The other presented with proximal disconnection of the catheter, which led to surgical replacement of the catheter. The pain disappeared after this surgery.ConclusionIntrathecal baclofen therapy with a subcutaneously implanted progammable pump can be complicated by radiculalgy secondary to a conflict between the catheter and symptomatic root. The diagnosis is made by CT lumbar scan. If medical treatment is not sufficient, surgery could be proposed to replace the catheter.

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