PMC155678_01
Five minutes film of intravenous urography, performed on day 487, shows good excretion of contrast by both kidneys. There is no hydronephrosis. The catheter is seen in the spinal canal. The tip of the catheter is located at T-10 level. There is no kink or dislodgement of catheter.
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F2
T-10 level. (Figure 2). The presence of radio opaque shadows in the region of urinary bladder was not noticed.
X-ray abdomen, taken on day 689, shows multiple radio opaque shadows in the region of urinary bladder. We failed to notice the absence of catheter in the spinal canal and coiling of catheter in paravertebral region at L-4 level.
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F3
Nine months after implantation of baclofen pump, X-ray of abdomen showed multiple radio opaque shadows in the region of urinary bladder. (Figure 3).
Flexible cystoscopy showed multiple calculi in the urinary bladder. Bladder stones acted as red herring for resurgence of spasticity whereas the true reason was spontaneous extrusion of catheter from the spinal canal.
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F4
Flexible cystoscopy confirmed the presence of vesical calculi. (Figure 4).
Chart shows dose of baclofen administered by simple, continuous infusion by Medtronic Synchromed pump. The patient required increasing dose of baclofen from 300 micrograms/day on day 412 to 1300 micrograms/day on day 738.
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F5
Even after removal of bladder stones, this patient required increasing dose of intrathecal baclofen. (Figure 5).
X-ray of abdomen, (close-up view of lumbar spine) which was taken on day 738 shows the catheter has come out of the spinal canal. The catheter is coiled in the paraspinal space at L-4 level.
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F6
The tip of catheter, which was placed at T-10 level, had extruded all the way down to paraspinal space at L-4, which was the site of entry of the catheter into subarachnoid space. (Figure 6).
CT of lumbar spine performed on day 759, shows the tip of catheter coiled superficially within the right longissimus lumborum muscle. Baclofen pump is located in the anterior abdominal wall.
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F7
CT scan showed the tip of catheter coiled superficially within the right longissimus lumborum muscle. (Figure 7).