Externalization of Intrathecal Baclofen Pumps Using a Shoulder Sling: Technique and Clinical Outcomes

To describe a novel axillary shoulder-sling technique for externalizing intrathecal baclofen (ITB) pumps and report its clinical outcomes in a cohort of patients requiring temporary pump removal for infection management.

We retrospectively reviewed 14 patients who underwent ITB pump externalization using the axillary sling technique between January 2020 and March 2025. The procedure involved tunneling a new catheter subcutaneously from the lumbar region to the midaxillary line and securing the pump within a sterile orthopedic stockinette loop positioned beneath the armpit. Pumps were maintained in the sling for approximately a median of 2 months, with weekly sterile sling changes and continuous baclofen infusion. Patients were closely monitored with regular follow-up visits, clinical examinations, and laboratory evaluations.

The median age of patients was 52 years (IQR: 38-69), with an equal male-to-female distribution. Hypertension and diabetes were the most frequent comorbidities (36% each). All pumps remained externalized for the median duration without a single incident of disconnection, infection recurrence, or exacerbation of spasticity. Every patient achieved resolution of infection and successful pump reimplantation. Patients reported improved comfort, more effortless mobility, and enhanced psychological well-being, compared with previous abdominal placements.

Axillary externalization of the ITB pump using a shoulder sling seems to be a secure, comfortable, and effective strategy for maintaining continuous baclofen delivery during infection management. Although this case series demonstrates favorable outcomes, the technique should be interpreted cautiously given the small, single-center cohort. This approach may offer a practical, reproducible option for temporary pump management, warranting further prospective validation.