Atypical baclofen pump catheter dislodgement in spastic cerebral palsy - A case report

Case DescriptionA 16-year-old male with spastic quadriparesis secondary to cerebral palsy underwent baclofen pump placement in August 2024. During a routine refill in September 2025, a hard, non-mobile bump was noted over the pump's central port. Ultrasound revealed low acoustic density material with tubelike structures at the site. Pediatric neurosurgery suspected catheter dislodgement, and the refill was deferred. Surgery two days later revealed that the pump tubing had migrated ventrally and calcified near the refill port, though the pump remained well-secured. Scar tissue was excised, and the tubing was repositioned behind the pump.DiscussionIt is estimated that 80-92% of patients diagnosed with cerebral palsy are affected by spasticity. Baclofen pumps are used when conservative treatments (e.g., bracing, therapy, oral antispasmodics, botulinum toxin) fail and require strict monitoring to ensure proper function. This case demonstrates an atypical baclofen pump catheter migration, where suspected dislodgement prevented the refill process, requiring surgical intervention. It underscores the importance of meticulous physical examination, ultrasound evaluation, and clinical judgment to prevent accidental catheter puncture during refills.ConclusionsRoutine follow-up with established care teams is essential for early detection of baclofen pump catheter dislodgement and to ensure proper positioning and function.