Intrathecal baclofen (ITB) therapy is a safe method for treating generalised spasticity which cannot be controlled by oral medication. Complications related to ITB therapy mostly consist of catheter related problems. Persons with a spinal cord injury are encouraged to be active even with an ITB pump and often take part in different sport activities.
A 37-year old male with a paraplegia T4 AIS A, secondary to a road traffic accident in 2003 presents at the outpatient clinic in September 2012 for refill of his ITB pump (SynchroMed II, Medtronic) placed in 2008 for uncontrollable spasticity of the lower limbs. Spasticity is well controlled and the patient doesn’t have any specific complaints. During refill-procedure, only 27 mL can be injected in the reservoir whereas the reservoir of the pump is made to contain 40 mL. Anamnesis reveals that three weeks before, the patient went scuba diving to a depth of 30 meters below sea-level. He does not recall any altering of spasticity during or after diving. X-ray reveals a collaps of the bottom shield of the baclofen pump.
This is the first clinical case reported of a patient with a mechanical deformation of an ITB pump following scuba diving. Scuba diving with a SynchroMed II pump (Medtronic) is restricted by the company to a depth of ten meters or 33 feet below sea-level as testing has shown that the pump may be damaged during a single exposure when the pump is not full and exposed to pressures greater than 2.0 ATA (atmospheres absolute), or with repeated exposure to increased pressures even if they are less than 2.0 ATA. Besides the permanent effect of a collapsing bottom shield, there is the temporary effect of reduced flow rate.
Patients with an ITB pump should be warned for the risks associated with scuba diving and should not dive more than 10 meters below sea-level.
Draulans N, Roels E, Kiekens C, Nuttin B, Peers K. Permanent mechanical deformation of an intrathecal baclofen pump secondary to altered pressure in scuba diving: a case report. Under revision in Spinal Cord
Keywords : spinal cord injury, spasticity, intrathecal baclofen therapy, scuba diving