Intrathecal Therapy in a Patient With Solid Arthrodesis of the Interlaminar Spaces: A Case Report

Intrathecal drug delivery is an established therapy for refractory chronic pain, but catheter placement may be challenging after spinal fusion. We report a 48-year-old woman with previous L2-S1 arthrodesis who underwent intrathecal catheter placement via a fluoroscopy-guided percutaneous transosseous approach using a hand bone drill after conventional fluoroscopic access was not feasible and open surgery was aborted. The procedure was complicated by a large dural defect and cerebrospinal fluid leak, successfully managed with sequential caudal epidural blood patches. This report highlights the feasibility of transosseous access in complex anatomy and the role of targeted blood patching in managing dural defects.