Managing Baclofen Pump Infection with an Externalized Intrathecal Catheter: A Viable Bridging Option

Intrathecal baclofen therapy provides effective relief for severe spasticity, but pump infections pose a critical management challenge. Standard care involves removing both the pump and the catheter, often necessitating rapid transition to oral therapy, which may be poorly tolerated in high-dose or anatomically complex patients.

A 47-year-old man with spastic quadriplegic cerebral palsy, prior spinal fusion, and longstanding intrathecal baclofen therapy developed a pump site infection 5 days after pump replacement. The pump was explanted, but the catheter was preserved and externalized under sterile conditions. Continuous intrathecal infusion at 30 μg/hr, with gradual introduction of oral baclofen, maintained neurologic stability without withdrawal. Following a 10-day antibiotic course, the pump was successfully reimplanted using the preserved catheter.

Externalization of an intrathecal catheter can serve as a safe bridging strategy in pump infections, preventing withdrawal and enabling reimplantation in select high-risk patients.