862 - Peek-a-boo, I see you! Wound dehiscence from device erosion years after surgical implantation of an intrathecal pain pump for targeted spinal drug delivery (TDD).

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

AS

Akhila Sridharamurthy, MD

Researcher, Department of Rehabilitation Medicine, Nura Pain clinic
University of Minnesota Medical Center
Edina, Minnesota, United States

Corresponding Author(s)

DS

David Schultz, MD

Founder & CEO
Nura Pain Clinic, Edina, MN
Edina, Minnesota, United States

Co-Author(s)

CL

Collin S. Larmour, BS

Clinical Research Coordinator
Nura Pain Cilnic, Edina
Edina, Minnesota, United States
EB

Erin Bettendorf, MD

Anesthesiologist and Interventional Pain Physician
Nura Pain Clinic, Edina
Edina, Minnesota, United States

Case Diagnosis: Wound dehiscence from device erosion years after surgical implantation of an intrathecal pain pump for targeted spinal drug delivery (TDD).

Case Description: A-65-year-old male underwent implant of an intrathecal pain pump into an abdominal pocket in 2006 to treat phantom limb pain and underwent revision of the pump pocket in 2016 for poor wound healing. He subsequently did well with good pain control. He presented to his primary care physician 6 weeks after he noticed the pump visibly protruding through the healed pump pocket scar in 2023. There was no history of trauma, pain at the pump pocket site or signs & symptoms of infection. Past medical history included well-controlled Type 2 diabetes mellitus, chronic hepatitis C and cigarette smoking. He did not take immunosuppressive medications.

Discussions: Targeted spinal drug delivery (TDD) is an evidenced-based option for management of chronic and cancer pain. Infection occurs in 2-8 % of patients with presentation varying from surgical site infection to rare meningitis. Infection may result from the surgical implant procedure, refilling of the reservoir through the skin via the pump access port, or indirectly via hematogenous seeding from an unrelated distant source. Factors which may increase infection risk include diabetes, immunosuppression, smoking, poor hygiene, and lapses in sterile technique when pumps are filled. In this case, no signs or symptoms of infection were present despite erosion of pump through the skin in delayed fashion. We believe infection was prevented because the wound remained open to air for over six weeks. The pump and catheter were explanted, and skin primarily closed and he did well.

Conclusions: Although rare, pump pocket dehiscence may occur many years following pump implant in patients with high risk factors for poor wound healing. Close patient follow-up and patient education can help maintain safe and effective spinal drug delivery and continued pain relief.