Swelling Around the Pump

Following surgery for the implantation of the Baclofen pump, you may notice swelling around the pump and the incision site in the back.

Whilst some inflammation is routine, one should keep an eye out for excessive swelling. Sometimes following the implantation of the pump, a drain will be inserted near the pump to take away any fluid collecting around the surrounding tissue, this fluid is called "Seroma", and is the body's natural healing mechanism to surgery. Over time this fluid will be absorbed by the body and is not to be worried about too much.

Another way to reduce swelling of the pump area, is to wear an elasticated abdominal binder. This will also help support the pump whilst the surrounding tissue heals, and will help the incision site in the back heal better as well.

Infection

If the fluid returns after the drain has been removed, and the area around the pump looks red, and feels warmer than the surrounding skin, it may be possible in rare cases that the incision site has become infected. This infection requires immediate antibiotics, as the infection can spread along the catheter and into the intrathecal space causing an infection around the spinal cord called meningitis.

If the infection around the pump is severe, the pump may need to be removed and the patient treated with IV antibiotics. It is usually possible to reimplant the pump around three months after completion of the course of antibiotics.

Cerebral Spinal Fluid Leak

Sometimes following surgery, the hole through which the catheter enters the intrathecal space may not heal properly. The needle used to make the hole in the dura during surgery is larger than that of the catheter which enters the intrathecal space. This results in Cerebral Spinal Fluid (CSF) leaking from the spine. The leak will be characterised by a swelling of the incision site around the back, and pump site. To the touch, this swelling will feel "spongy", and when lightly tapped, will ripple slightly as the fluid moves around. Also the patient may experience a "spinal headache".

A CSF leak may initially treated by the patient laying flat for 48 hours with no head pillow. This reduces the pressure of CSF around the Catheter entry point into the spine, thus giving the tissue time to heal. The patient will also be encouraged to drink plenty of fluids to help replace the lost CSF.

If laying flat does not work, then a procedure called a "blood patch" may be performed. A blood patch is when some of the patients blood is taken, usually from the arm, and injected using a lumbar puncture around the catheter entry point in the back. This blood then mixes with the CSF, clots, and plugs the hole from where the CSF is leaking. The patient will then have to lay flat for a couple of days to make sure the leak has stopped, and once the patient is mobilised, they may also need to wear an abdominal binder.


copyright 2004. Simon Roulstone