What is an intrathecal pump?

An intrathecal pump is a battery-operated device which delivers medication directly into the spinal canal. Intrathecal pumps may be used to treat chronic pain or spasticity, and is sometimes used to treat cancer-related pain.
The spinal canal contains a large amount of fluid (cerebrospinal fluid or CSF), in which the nerves bathe. By inserting a small tube which is connected to a programmable reservoir, medications such as pain-killers can be directly delivered to these nerves.

The reservoir (or chamber) is implanted under the skin of the abdomen or back, and can be refilled from time to time by inserting a small needle through the skin.

Which conditions can be treated using an intrathecal pump?

1. Chronic pain conditions
   • Complex regional pain syndrome (neuropathic pain)
   • Multiple sclerosis pain
   • Failed back surgery pain
2. Cancer-related pain
3. Spasticity
   • Cerebral palsy
   • Brain injury

What are the reasons for surgery?

When medications and other treatments are no longer working well or their side effects are to severe, surgery may be of value.

What are the benefits of intrathecal medication delivery?

• Effective pain relief
• Reduced side effects (eg. drowsiness) of pain medications
• Improved quality of life

What are the alternatives to surgery?

A number of medications may be useful for pain. These include the standard opioid and non-opioid analgesic agents, anti-inflammatory medications, membrane stabilising agents and anticonvulsants, as well as the most recent agent to be released- Pregabalin. Special medical treatments such as Ketamine infusions, local nerve and joint blocks, as well as other surgical options such as spinal cord stimulation should also be considered.

What do you need to tell the doctor before surgery?

It is important that you tell your surgeon if you:

• Have blood clotting or bleeding problems
• Have ever had blood clots in your legs (DVT or deep venous thrombosis) or lungs (pulmonary emboli)
• Are taking aspirin, warfarin, or anything else (even some herbal supplements) that might thin your blood
• Have high blood pressure
• Have any allergies
• Have any other health problems

What happens before surgery?

If your problem is pain, we will send you pain charts to fill in. These are important in planning your surgery and monitoring your response. The first chart is a body map. You should shade in the areas of your body that are affected with pain. The second chart is a pain diary. Fill this in over a period of a week or so. If your pain varies over the day, do a few scores per day, but if your pain tends to stay the same over the day a daily score will be enough. The third chart is called McGill Questionnaire. This chart does not rely on numbers but helps you to describe your pain to us. As it states on the form, not every group of words may apply to you. Pick the words that best describe your pain.

Who will perform surgery? Who else will be involved?

Surgery will be carried out by your Precision Neurosurgery surgeon. A surgical assistant will be present and an experienced anaesthetist will be responsible for your anaesthetic or sedation.

What are the aims and potential benefits of surgery?

The goals and potential benefits of surgery include:

• Pain reduction
• Decreased spasticity
• Reduced medication requirements

The chance of obtaining a significant benefit from surgery depends upon a wide variety of factors. Your neurosurgeon will give you an indication of the likelihood of success in your specific case.

What are the possible outcomes if treatment is not undertaken?

Potential outcomes of not treating your condition include:

• Ongoing pain or spasticity
• Reduced quality of life

How is the procedure performed?

An intrathecal pump is inserted via a simple and safe surgical procedure. A small incision is made in the back, and a flexible catheter introduced into the spinal canal. This is then connected to a battery-operated pump which is placed under the skin of the abdomen. Complications are uncommon, and may include bleeding and infection. The patient is discharged on either the same day or on the day after surgery.

What are the specific risks of this type of surgery?

As with all types of surgery, there is a small chance of complications.

• There is a small risk of infection (3%)
• There could be movement or blockage of the catheter, and it may need to be replaced in a separate procedure
• Failure of the pump
• Small risk of bleeding
• Spinal fluid leak is very uncommon
• Paraplegia or quadriplegia, incontinence or impotence are rare
• The risk of death is extremely small (less than 1 in 30,000)

What are the risks of anaesthesia and the general risks of surgery?

• Significant scarring (‘keloid’)
• Wound breakdown
• Drug allergies
• DVT (‘economy class syndrome’)
• Pulmonary embolism (blood clot in lungs)
• Chest and urinary tract infections
• Pressure injuries to nerves in arms and legs
• Eye or teeth injuries
• Myocardial infarction (‘heart attack’)
• Stroke
• Loss of life
• Other rare complications

What happens down the track?

Your pain specialist will keep in close contact with you after your discharge from hospital. You will probably require programming adjustments over the first few months to optimise your pain relief. Your pain medications can be reduced as tolerated.

How long will the benefits last?

This will vary from patient to patient. Typically, patients obtain a benefit for several years or longer.

What should you notify your doctor of after surgery?

• Fever
• Redness, swelling or possible infection of the wounds
• Weakness or numbness in the arms or legs
• New loss of bowel or bladder control
• Worsening pain
• Any other concerns

What are the costs of surgery?

Private patients undergoing surgery will generally have some out-of-pocket expenses.
A quotation for surgery will be issued, however this is an estimate only. The final amount charged may vary with the eventual procedure undertaken, operative findings, technical issues etc. Patients are advised to consult with their Private Health Insurance provider and Medicare to determine the extent of out-of-pocket expenses.

Separate accounts will be rendered by the anaesthetist and sometimes the assistant, and hospital bed excess charges may apply. Medical expenses may be tax deductible (you should ask your accountant).

You should fully understand the costs involved with surgery before going ahead, and should discuss any queries with your surgeon.

What is the consent process?

You will be asked to sign a consent form before surgery. This form confirms that you understand all of the treatment options, as well as the risks and potential benefits of surgery. If you are unsure, you should ask for further information and only sign the form when you are completely satisfied.