ABSTRACT
This chapter presents the surgical procedure for intrathecal baclofen pump placement. The patient is anaesthetised and placed in the lateral position with the upper arm on a support and a small bolster under the dependent axilla. This exposes the abdominal wall and allows insertion of the lumbar catheter. Prophylactic intravenous antibiotics are administered according to local protocol. The catheter and guidewire are inserted through the needle when CSF is obtained. The stylet may be replaced temporarily to minimise CSF loss. Horizontal beam X-ray is used to locate the radio-opaque mark at the end of the guidewire. The catheter and guidewire can be passed further to reach the desired level, but they must not be withdrawn through the Tuohy needle, as this can damage the catheter. The catheter is held in place as the needle is removed. The anchor and its applicator are then passed over the catheter until the anchor tip is in the lumbar fascia.
