Use of O-arm to place an intrathecal catheter through a bony fusion mass: case report.
Francesco Sammartino, Sheital Bavishi, Brian Dalm
PMID 40476074WHAT IT FOUND
3D navigation guided intrathecal baclofen catheter placement through a fusion gap in a woman with spinal cord injury spasticity.
After oral baclofen and methocarbamol were stopped, she had lower-limb Ashworth scores of 0 and could sit at work for 12 h.
Key findings
01Fluoroscopy did not access the intrathecal space, so the team used 3D image guidance to proceed with pump and catheter implantation.
02At 22 months, the patient remained on intrathecal baclofen, off oral baclofen and methocarbamol, and had lower-limb Ashworth scores of 0.
03She could work sitting in her chair for up to 12 h per day without spasms affecting her working ability.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a single case report, so it cannot show how often the technique works or whether the pump caused the reported improvement. The patient had several treatments: intrathecal baclofen, oral baclofen, methocarbamol, and botulinum toxin injections into the bladder. The contribution of any single component cannot be separated. No intrathecal baclofen trial was completed before implantation, and the authors note this decision is controversial. Follow-up was 22 months, and the authors state there is limited generalizability and no extensive long-term follow-up. The paper does not describe a physical therapy or occupational therapy programme, so it does not show how therapists should manage these patients.
Declared interests
The authors declare that no financial support was received for the research or publication.
The easy way to misread this
Do not read this as evidence that intrathecal baclofen reliably improves spasticity or that O-arm navigation is required. It is a single case report, the patient also had oral baclofen and methocarbamol stopped and prior botulinum toxin injections into the bladder, and no comparison group tested the pump or the navigation method.