(371) Intrathecal catheter migration causing upper extremity myelopathy: a case report

58 year old Caucasian female with multiple sclerosis and spastic quadriparesis who was being followed in an ambulatory surgical center for reprogramming and maintenance of her baclofen pump, presented with left upper extremity tingling and intermittent shock-like pain from her left posterior shoulder down into her fingers. These symptoms were preceded by a fall backwards from her wheelchair, where she landed on her head. Examination revealed decreased sensation to pin-prick and decreased proprioception in the left upper extremity; decreased ROM and strength in bilateral upper extremities, and spasticity noted in all four extremities. Spurling's test was equivocal on the left and negative on the right with hypoactive reflexes in biceps, brachioradialis, and triceps bilaterally. CT Myelogram showed an intrathecal catheter with tip projecting 3mm into the left paramidline dorsal spinal cord at the C7-T1 level. After results of the CT myelogram was discussed with neurosurgery, she was subsequently scheduled for surgery to reposition the distal catheter tip under intraoperative fluoroscopy. The catheter was mobilized 2.5 cm inferiorly. After the surgery, patient had complete resolution of her symptoms. Typically, intrathecal baclofen therapy is a highly effective treatment option for patients with refractory spasticity and dystonia, and complication rates from catheter migration remain relatively low. However, in the setting of an inciting event such as trauma, the catheter can migrate or become dislodged and cause impingement on the spinal cord and result in a presentation of neuropathic symptoms caused by underlying myelopathy.