Implanted intrathecal pump catheter migration rates in the management of cancer-related pain.

Abstract

Intrathecal drug delivery systems offer a potent modality for managing cancer-related pain that is resistant to conservative measures. However, catheter-related complications, particularly migration, remain a concern. This study assessed the prevalence, risk factors, and implications of catheter migration rates in patients with intrathecal pumps (ITP) for cancer-related pain. A retrospective database and chart review of 441 patients with cancer with an ITP at the Huntsman Cancer Institute from May 2014 to December 2023 was performed to identify patients who had two chest CT scans after implant separation by at least 30 days. Catheter migration was defined as movement of the catheter by one or more vertebral levels when comparing the two imaging studies. Demographics were analyzed to identify factors associated with migration. To identify subjects with catheter complications missed by the initial approach, an additional chart review was performed to identify operative procedures linked to catheter revision. 117 patients were suitable for analysis, and 15.4% (n=18) had catheter migration between the two CT scans. These were all limited to a single vertebral level. Across the full cohort of 441 patients, radiographically significant migration requiring revision occurred in only two patients (0.45%). No demographic or clinical factors were significantly associated with migration. Minor catheter migration is relatively common following ITP implantation, but clinically significant migration is rare with the anchoring and closure techniques described.