Case Presentation Observational Analysis of Successful Reimplantation of Explanted Intrathecal Drug Delivery Systems: A Case Series Yinn Cher Ooi, BS, Michael Saulino, MD, PhD, Kim A. Williams, Jr., MD, Ashwini Sharan, MD INTRODUCTION The intrathecal drug delivery system (ITDDS) allows direct infusion of analgesic and antispasticity drugs into the cerebral spinal fluid of patients with chronic intractable pain and spasticity. Intrathecal baclofen therapy is a viable option for the treatment of severe spasticity from spinal cord injuries, anoxic and traumatic brain injuries, cerebral palsy, and multiple sclerosis [1]. In addition, ITDDS has also been shown to be effective in providing symptomatic relief in patients with chronic pain refractory to conventional therapies [2]. ITDDS allows use of lower doses of pharmacologic agents for symptomatic relief, potentially limiting side effects associated with the use of high doses of systemic drugs such as those for sedation, respiratory depression, and constipation [3-7]. Infection and incisional dehiscence are potential complications of intrathecal therapy. Infectious complications consist of surgical site infection, deep pocket infection, pump contamination, and meningitis. Often, these complications lead to rapid system explanta- tion. These events can be devastating because they expose patients to risks of withdrawal, sepsis, and central nervous system infections. There is limited discussion in the medical literature regarding guidelines for reimplantation in patients experiencing explantion sec- ondary to infectious complications. The purpose of this case series report is to review our experience of reimplantation of ITDDS in patients who initially experienced infectious complications requiring device explantation. Various management strategies for these challenging clinical situations will also be discussed. A retrospective, institutional review board–approved chart review of our institution’s intrathecal therapy program was undertaken. Charts of patients who underwent explanta- tion and reimplantation and those who did not undergo reimplantation between January 2001 and December 2009 were reviewed. The following data were obtained: patient age, gender, diagnosis, ITDDS implant site, reason for explantation, period between explanta- tion and reimplantation, general nutritional status, body habitus, follow-up period, and complications. All surgical procedures were performed by 1 neurosurgeon, and all fol- low-up pump management was done by 1 physiatrist. No pump management was under- taken by home health service providers A telephone interview was also conducted on the identified patients to obtain relevant additional history and current status of ITDDS. A systematic literature search was performed for English-language studies that examined complications associated with ITDDS. Two databases (PubMed and Scopus) were searched for reports published up to January 2010. Studies that reported infectious complications, treatment of infectious complications by explantation, and subsequent reimplantation were reviewed. Rates of explantation and reimplantation were tabulated and compared with those of our case series. FINDINGS Between January 2001 and December 2009, 274 implant procedures were performed involving 166 new patients. Twelve patients had their ITDDS explanted; 8 were secondary to an infection or wound dehiscence, whereas the remaining 4 were secondary to hardware failure (all 4 were subsequently reimplanted). Primary diagnoses in these 8 patients Y.C.O. Department of Neurological Surgery, Thomas Jefferson University Hospital, Phila- delphia, PA. Disclosure: nothing to disclose M.S. Department of Physical Medicine and Rehab, MossRehab, Albert Einstein Hospital Disclosure: 3B, Medtronic K.A.W. Department of Neurological Surgery, Thomas Jefferson University Hospital, Phila- delphia, PA Disclosure: nothing to disclose A.S. Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107. Ad- dress correspondence to: A.S.; e-mail: ashwini. sharan@jefferson.edu Disclosure: 2A, Covidian, Medtronic; 2B, St. Jude; 3A, Integra; 3B, St. Jude; 4B, Zimmer Spine; 7A, St. Jude Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org Submitted for publication May 29, 2010; accepted August 12, 2010. PM&R © 2011 by the American Academy of Physical Medicine and Rehabilitation 1934-1482/11/$36.00 Vol. 3, 175-178, February 2011 Printed in U.S.A. DOI: 10.1016/j.pmrj.2010.08.004 175