High-Resolution Three-Dimensional Computed Tomography for Assessing Complications Related to Intrathecal Drug Delivery

Pain Physician. 2016 Jul;19(5):E775-80.

Abstract

Background: The assessment of the functionality of intrathecal drug delivery (IDD) systems remains difficult and time-consuming. Catheter-related problems are still very common, and sometimes difficult to diagnose.

Objectives: The aim of the present study is to investigate the accuracy of high-resolution three-dimensional computed tomography (CT) in order to detect catheter-related pump dysfunction.

Study design: An observational, retrospective investigation.

Setting: Academic medical center in Germany.

Methods: We used high-resolution three dimensional (3D) computed tomography with volume rendering technique (VRT) or fluoroscopy and conventional axial-CT to assess IDD-related complications in 51 patients from our institution who had IDD systems implanted for the treatment of chronic pain or spasticity.

Results: Twelve patients (23.5%) presented a total of 22 complications. The main type of complication in our series was catheter-related (50%), followed by pump failure, infection, and inappropriate refilling. Fluoroscopy and conventional CT were used in 12 cases. High-resolution 3D CT VRT scan was used in 35 instances with suspected yet unclear complications. Using 3D-CT (VRT) the sensitivity was 58.93% - 100% (CI 95%) and the specificity 87.54% - 100% (CI 95%).The positive predictive value was 58.93% - 100% (CI 95%) and the negative predictive value: 87.54% - 100% (CI 95%).Fluoroscopy and axial CT as a combined diagnostic tool had a sensitivity of 8.3% - 91.7% (CI 95%) and a specificity of 62.9% - 100% (CI 95%). The positive predictive value was 19.29% - 100% (CI 95%) and the negative predictive value: 44.43% - 96.89% (CI 95%).

Limitations: This study is limited by its observational design and the small number of cases.

Conclusion: High-resolution 3D CT VRT is a non- invasive method that can identify IDD-related complications with more precision than axial CT and fluoroscopy.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Catheters / adverse effects*
  • Chronic Pain / drug therapy
  • Female
  • Germany
  • Humans
  • Imaging, Three-Dimensional / standards*
  • Infusion Pumps / adverse effects*
  • Infusions, Spinal / adverse effects*
  • Male
  • Middle Aged
  • Muscle Spasticity / drug therapy
  • Postoperative Complications / diagnostic imaging*
  • Predictive Value of Tests
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / standards*
  • Young Adult