Introduction: The approach to intrathecal (IT) drug delivery malfunction is complicated, particularly for iodine-allergic patients. In these situations, the current literature has not addressed the use of IT gadolinium. Case reports exist showing severe neurotoxic manifestations with IT gadolinium use. We sought to provide a resource for chronic pain physicians treating an iodine-allergic patient and considering the use of IT gadolinium.
Methods: A thorough literature search identified 11 published cases of gadolinium-induced neurotoxicity due to IT injection and those cases are described in detail. The literature was also reviewed for safe dosages of IT gadolinium.
Results: After thorough review, a safe IT gadolinium dose is provided. Additionally, an algorithm was developed for the workup of an IT pump malfunction in iodine allergic patients.
Conclusion: Herein, we provide guidance on IT gadolinium usage and a framework for IT pump malfunction in iodine allergic patients.
Keywords: Chronic pain; gadolinium; intrathecal drug delivery; programmable pump; safety.
© 2019 International Neuromodulation Society.