An Intrathecally Located Broken Catheter Used for an Intrathecal Drug Delivery System

The intrathecal drug delivery system (ITDDS), an effective treatment tool for intractable spasticity and pain, is associated with various complications but breakage of the catheter is rare. We report the case of a 50-yr-old man with ITDDS, in whom an intrathecal catheter was severed, resulting in a 28.6-cm-long intrathecal fragment. The catheter completely retracted into the intrathecal space from the anchor site. The catheter was severed during spine flexion, and the total distal fragment was repositioned in the intrathecal space. Although the outcome of ITDDS was associated with the length or diameter of the broken catheter, no neurologic complications occurred in our patient. Thus, we inserted another catheter instead of removing the old one. Thereafter, the patient has been regularly followed up, and no neurologic complications have developed during the 28 months.

Proposing a Scoring System for the Research Criteria of Complex Regional Pain Syndrome

This study evaluated the structure of complex regional pain syndrome (CRPS) population and suggested a weighted scoring system to balance on objective signs. One hundred sixty-eight consecutive patients were evaluated using the Budapest Research Criteria (BRC). By using multidimensional scaling and logistic regression analysis, we analyzed the degree of importance and relationships between objective findings. In addition, a receiver operating characteristic curve was constructed using a weighted score derived from the risk ratio as a diagnostic test. There were correlations between skin color change and edema, and between decreased range of motion and motor dysfunction when multidimensional scaling was applied. The trophic change was excluded by a logistic regression (95% CI; 0.80-11.850). The cutoff point based on weighted score derived from the risk ratios for determining CRPS was 7.88. At this point, the sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 95.3%, 96.3%, and 70.1%, respectively. We propose a weighted scoring system for the BRC using risk ratios of objective signs. Although a thorough systematic review would be required in the future, this study can contribute to reduction of the possible distortion of the feature of CRPS populations by the BRC.