Intrathecal Drug Delivery Device [Neurosurgery Wiki]

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====== Intrathecal Drug Delivery Device ======

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[[Intrathecal]] [[drug delivery device]]s (IDDDs) are a mainstay in the treatment of [[spasticity]] and [[refractory]] [[pain]]. 
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Intrathecal drug delivery (IDD) is part of the [[fourth analgesic step]]. Evidence on the quality of life of patients with refractory chronic non-[[cancer pain]] (CNCP) using these devices and their long-term outcomes is scarce. A study aimed to evaluate patients with IDD to assess their HRQoL. Additionally, the study seeks to understand the patients' satisfaction with the treatment and changes in pain magnitude over time. 
Adult patients with CNCP and intrathecal drug delivery systems (IDDS) were included. The study population was divided into two groups: less than and more than 15 years of treatment. HRQoL was analyzed using validated questionnaires. Pain reduction was assessed using the visual analog scale (VAS), and treatment satisfaction was evaluated using the Patient Global Impression of Improvement scale. Results: The results indicate a poor HRQoL in IDD patients, with better scores in the group with ≥15 years of treatment. Pain reduction was similar in both groups, and patients reported a positive satisfaction level with the treatment. 
HRQoL in CNCP patients is severely affected. Long-term IDD patients have a similar or even better HRQoL in some respects compared to those with shorter follow-ups. IDD patients experienced pain reduction, with most feeling better or much better
((Sánchez-García MA, Alcázar-Navarrete B, Cortiñas-Saenz M, Cordero Tous N, Gálvez Mateos R. Multidimensional Analysis of Quality of Life in Patients with Chronic Non-Cancer Pain and Short- and Long-Term Intrathecal Analgesic Therapy. Healthcare (Basel). 2024 Sep 18;12(18):1870. doi: 10.3390/healthcare12181870. PMID: 39337211; PMCID: PMC11431655.)).
----


===== Complications =====

see [[Intrathecal Drug Delivery Device complications]].

===== Unclassified ===== 

Deer T, Kim P, Pope JE, Hayek S, McDowell G, Mekhail N, Diwan S, Saulino M,
Moeschler S, Schultz D, Gritsenko K, Prager J, Peterson EA, Staats P, Poree L,
Fishman MA, Vallejo R, Calodney A, Slavin K, de Leon Cassadala O, Levy R,
Buvanendran A, Sitzman BT, Sayed D, Ferrante FM, Kloth D, Gilligan CJ, Kapural L,
Kloster DR, Leong M, Rosenow JM, Lamer TJ, Stearns L. Guest Editorial: Physician 
Guidance on the Use of Off-Labeled Drugs in Intrathecal Drug Delivery Systems for
Chronic Pain. Neuromodulation. 2019 Apr 30. doi: 10.1111/ner.12961. [Epub ahead
of print] PubMed PMID: 31039292.



2: Kim AJ, Basu S, Glass C, Ross EL, Agar N, He Q, Calligaris D. Unique
Intradural Inflammatory Mass Containing Precipitated Morphine: Confirmatory
Analysis by LESA-MS and MALDI-MS. Pain Pract. 2018 Sep;18(7):889-894. doi:
10.1111/papr.12688. Epub 2018 Mar 30. PubMed PMID: 29480977; PubMed Central
PMCID: PMC6109606.


3: Devine OP, Harborne AC, Lo WB, Price R. Colonic perforation by an intrathecal 
baclofen pump catheter causing delayed Escherichia coli meningitis. BMJ Case Rep.
2017 Dec 20;2017. pii: bcr-2017-222539. doi: 10.1136/bcr-2017-222539. PubMed
PMID: 29269368.


4: Nagel SJ, Reddy CG, Frizon LA, Holland MT, Machado AG, Gillies GT, Howard MA
3rd. Intrathecal Therapeutics: Device Design, Access Methods, and Complication
Mitigation. Neuromodulation. 2018 Oct;21(7):625-640. doi: 10.1111/ner.12693. Epub
2017 Sep 29. Review. PubMed PMID: 28961351.


5: Delhaas EM, Harhangi BS, Frankema SPG, Huygen FJPM, van der Lugt A. Plain
radiography in patients treated with intrathecal drug delivery using an
implantable pump device. Insights Imaging. 2017 Oct;8(5):499-511. doi:
10.1007/s13244-017-0568-z. Epub 2017 Aug 24. PubMed PMID: 28840489; PubMed
Central PMCID: PMC5621993.


6: Warner NS, Bendel MA, Warner MA, Strand JJ, Gazelka HM, Hoelzer BC, Mauck WD, 
Lamer TJ, Kor DJ, Moeschler SM. Bleeding Complications in Patients Undergoing
Intrathecal Drug Delivery System Implantation. Pain Med. 2017 Dec
1;18(12):2422-2427. doi: 10.1093/pm/pnw363. PubMed PMID: 28340041.


7: Cohen-Pfeffer JL, Gururangan S, Lester T, Lim DA, Shaywitz AJ, Westphal M,
Slavc I. Intracerebroventricular Delivery as a Safe, Long-Term Route of Drug
Administration. Pediatr Neurol. 2017 Feb;67:23-35. doi:
10.1016/j.pediatrneurol.2016.10.022. Epub 2016 Nov 10. Review. PubMed PMID:
28089765.


8: Deer TR, Pope JE, Hayek SM, Lamer TJ, Veizi IE, Erdek M, Wallace MS, Grider
JS, Levy RM, Prager J, Rosen SM, Saulino M, Yaksh TL, De Andrés JA, Abejon
Gonzalez D, Vesper J, Schu S, Simpson B, Mekhail N. The Polyanalgesic Consensus
Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for
Improving Safety and Mitigating Risks. Neuromodulation. 2017 Feb;20(2):155-176.
doi: 10.1111/ner.12579. Epub 2017 Jan 2. Review. PubMed PMID: 28042914.


9: Prusik J, Argoff C, Peng S, Pilitsis JG. Use of Low Dose Ziconotide as
First-Line Intrathecal Monotherapy. Neuromodulation. 2017 Jun;20(4):386-391. doi:
10.1111/ner.12486. Epub 2016 Aug 5. PubMed PMID: 27492135.


10: Morgalla M, Fortunato M, Azam A, Tatagiba M, Lepski G. High-Resolution
Three-Dimensional Computed Tomography for Assessing Complications Related to
Intrathecal Drug Delivery. Pain Physician. 2016 Jul;19(5):E775-80. PubMed PMID:
27389121.


11: Han JL, Loriaux DB, Tybout C, Kinon MD, Rahimpour S, Runyon SL, Hopkins TJ,
Boortz-Marx RL, Lad SP. Thoracic Nerve Root Entrapment by Intrathecal Catheter
Coiling: Case Report and Review of the Literature. Pain Physician. 2016
Mar;19(3):E499-504. Review. PubMed PMID: 27008308.


12: Veizi E, Tornero-Bold M, Hayek SM. Resolution of Intrathecal Hydromorphone or
Morphine-induced Peripheral Edema by Opioid Rotation to Fentanyl: A Case Series. 
Pain Pract. 2016 Jul;16(6):E94-8. doi: 10.1111/papr.12443. Epub 2016 Mar 15.
PubMed PMID: 26990069.


13: Hayek SM, Sweet JA, Miller JP, Sayegh RR. Successful Management of Corneal
Neuropathic Pain with Intrathecal Targeted Drug Delivery. Pain Med. 2016
Jul;17(7):1302-7. doi: 10.1093/pm/pnv058. Epub 2015 Dec 14. PubMed PMID:
26814286.


14: Hayek SM, Veizi E, Hanes M. Intrathecal Hydromorphone and Bupivacaine
Combination Therapy for Post-Laminectomy Syndrome Optimized with
Patient-Activated Bolus Device. Pain Med. 2016 Mar;17(3):561-571. Epub 2015 Dec
14. PubMed PMID: 26814257.


15: Devine O, Harborne A, Lo WB, Weinberg D, Ciras M, Price R. Unusual placement 
of intrathecal baclofen pumps: report of two cases. Acta Neurochir (Wien). 2016
Jan;158(1):167-70. doi: 10.1007/s00701-015-2636-9. Epub 2015 Nov 23. PubMed PMID:
26592253; PubMed Central PMCID: PMC4684582.


16: Ingale H, Ughratdar I, Muquit S, Moussa AA, Vloeberghs MH. Selective dorsal
rhizotomy as an alternative to intrathecal baclofen pump replacement in GMFCS
grades 4 and 5 children. Childs Nerv Syst. 2016 Feb;32(2):321-5. doi:
10.1007/s00381-015-2950-9. Epub 2015 Nov 9. PubMed PMID: 26552383.


17: Kratzsch T, Stienen MN, Reck T, Hildebrandt G, Hoederath P. Catheter-tip
Granulomas Associated with Intrathecal Drug Delivery--A Two-Center Experience
Identifying 13 Cases. Pain Physician. 2015 Sep-Oct;18(5):E831-40. PubMed PMID:
26431137.


18: Stetkarova I, Brabec K, Vasko P, Mencl L. Intrathecal Baclofen in Spinal
Spasticity: Frequency and Severity of Withdrawal Syndrome. Pain Physician. 2015
Jul-Aug;18(4):E633-41. PubMed PMID: 26218954.


19: Muenzer J, Hendriksz CJ, Fan Z, Vijayaraghavan S, Perry V, Santra S, Solanki 
GA, Mascelli MA, Pan L, Wang N, Sciarappa K, Barbier AJ. A phase I/II study of
intrathecal idursulfase-IT in children with severe mucopolysaccharidosis II.
Genet Med. 2016 Jan;18(1):73-81. doi: 10.1038/gim.2015.36. Epub 2015 Apr 2.
PubMed PMID: 25834948.


20: Etminan N, Macdonald RL, Davis C, Burton K, Steiger HJ, Hänggi D. Intrathecal
application of the nimodipine slow-release microparticle system eg-1962 for
prevention of delayed cerebral ischemia and improvement of outcome after
aneurysmal subarachnoid hemorrhage. Acta Neurochir Suppl. 2015;120:281-6. doi:
10.1007/978-3-319-04981-6_47. Review. PubMed PMID: 25366637.


21: Gulati A, Shah R, Puttanniah V, Hung JC, Malhotra V. A retrospective review
and treatment paradigm of interventional therapies for patients suffering from
intractable thoracic chest wall pain in the oncologic population. Pain Med. 2015 
Apr;16(4):802-10. doi: 10.1111/pme.12558. Epub 2014 Sep 19. Review. PubMed PMID: 
25236160.


22: Waqar M, Ellenbogen JR, Kumar R, Sneade C, Zebian B, Williams D, Pettorini
BL. Indwelling intrathecal catheter with subcutaneous abdominal reservoir: a
viable baclofen delivery system in severely cachectic patients. J Neurosurg
Pediatr. 2014 Oct;14(4):409-13. doi: 10.3171/2014.6.PEDS13686. Epub 2014 Aug 1.
PubMed PMID: 25084089.


23: Ghobrial GM, Thakkar V, Singhal S, Oppenlander ME, Maulucci CM, Harrop JS,
Jallo J, Prasad S, Saulino M, Sharan AD. Efficacy of intraoperative vancomycin
powder use in intrathecal baclofen pump implantation procedures: single
institutional series in a high risk population. J Clin Neurosci. 2014
Oct;21(10):1786-9. doi: 10.1016/j.jocn.2014.04.007. Epub 2014 Jun 14. PubMed
PMID: 24938386.


24: Bentley JN, Viswanathan A, Rosenberg WS, Patil PG. Treatment of medically
refractory cancer pain with a combination of intrathecal neuromodulation and
neurosurgical ablation: case series and literature review. Pain Med. 2014
Sep;15(9):1488-95. doi: 10.1111/pme.12481. Epub 2014 Jun 14. Review. PubMed PMID:
24931480.


25: Margetis K, Korfias SI, Gatzonis S, Boutos N, Stranjalis G, Boviatsis E,
Sakas DE. Intrathecal baclofen associated with improvement of consciousness
disorders in spasticity patients. Neuromodulation. 2014 Oct;17(7):699-704:
discussion 704. doi: 10.1111/ner.12147. Epub 2013 Dec 18. PubMed PMID: 24350688.


26: Taira T, Ueta T, Katayama Y, Kimizuka M, Nemoto A, Mizusawa H, Liu M, Koito
M, Hiro Y, Tanabe H. Rate of complications among the recipients of intrathecal
baclofen pump in Japan: a multicenter study. Neuromodulation. 2013
May-Jun;16(3):266-72; discussion 272. doi: 10.1111/ner.12010. Epub 2012 Dec 14.
PubMed PMID: 23240625.


27: Mascitelli J, De Los Reyes K, Steinberger J, Zou H. Lack of functionality and
need for revision of an Ommaya reservoir placed into a cavum septum pellucidum. J
Neurosurg. 2013 Mar;118(3):502-4. doi: 10.3171/2012.10.JNS12818. Epub 2012 Nov 2.
PubMed PMID: 23121429.


28: Yowtak J, Cato K, Williams H, Salazar P, Macomson S, Sekul E, Vender J.
Indium 111 diethylenetriamine pentaacetic acid scintigraphy in the identification
and management of intrathecal pump malfunction. PM R. 2013 Jan;5(1):32-8. doi:
10.1016/j.pmrj.2012.07.010. Epub 2012 Sep 12. PubMed PMID: 22981006.


29: Varhabhatla NC, Zuo Z. Rising complication rates after intrathecal catheter
and pump placement in the pediatric population: analysis of national data between
1997 and 2006. Pain Physician. 2012 Jan-Feb;15(1):65-74. PubMed PMID: 22270739.


30: Magro E, Remy-Neris O, Seizeur R, Allano V, Quinio B, Dam-Hieu P. Bilateral
subdural hematoma following implantation of intrathecal drug delivery device.
Neuromodulation. 2011 Mar-Apr;14(2):179-81; discussion 182. doi:
10.1111/j.1525-1403.2011.00335.x. Epub 2011 Mar 1. PubMed PMID: 21992208.


31: Medel R, Pouratian N, Elias WJ. Catheter-tip mass mimicking a spinal epidural
hematoma. J Neurosurg Spine. 2010 Jan;12(1):66-71. doi:
10.3171/2009.7.SPINE08888. PubMed PMID: 20043767.


32: Peerdeman SM, de Groot V, Feller RE. In situ treatment of an infected
intrathecal baclofen pump implant with gentamicin-impregnated collagen fleece. J 
Neurosurg. 2010 Jun;112(6):1308-10. doi: 10.3171/2009.8.JNS081692. PubMed PMID:
19731988.


33: Miller JP, Acar F, Burchiel KJ. Significant reduction in stereotactic and
functional neurosurgical hardware infection after local neomycin/polymyxin
application. J Neurosurg. 2009 Feb;110(2):247-50. PubMed PMID: 19263587.


34: Reif-Gintl T, Ilias W. [Palliative therapy in bronchial carcinoma--implanted 
delivery system and ports]. Wien Med Wochenschr. 2008;158(23-24):729-34. doi:
10.1007/s10354-008-0625-9. German. PubMed PMID: 19165455.


35: Omeis I, Chen W, Jhanwar-Uniyal M, Rozental R, Murali R, Abrahams JM.
Prevention of cerebral vasospasm by local delivery of cromakalim with a
biodegradable controlled-release system in a rat model of subarachnoid
hemorrhage. J Neurosurg. 2009 May;110(5):1015-20. doi: 10.3171/2008.8.JNS08202.
PubMed PMID: 19119878.


36: Aliabadi H, Osenbach RK. Intrathecal Drug Delivery Device Infection and
Meningitis due to Mycobacterium Fortuitum: A Case Report. Neuromodulation. 2008
Oct;11(4):311-4. doi: 10.1111/j.1525-1403.2008.00181.x. PubMed PMID: 22151146.


37: Taira T. [Chronic intrathecal drug administration for the control of
intractable pain]. Brain Nerve. 2008 May;60(5):509-17. Review. Japanese. PubMed
PMID: 18516973.


38: Flückiger B, Knecht H, Grossmann S, Felleiter P. Device-related complications
of long-term intrathecal drug therapy via implanted pumps. Spinal Cord. 2008
Sep;46(9):639-43. doi: 10.1038/sc.2008.24. Epub 2008 Mar 11. PubMed PMID:
18332884.


39: Vanhauwaert DJ, Kalala JP, Baert E, Hallaert G, Crombez E, Caemaert J, Van
Roost D. Migration of pump for intrathecal drug delivery into the peritoneal
cavity. Case report. Surg Neurol. 2009 May;71(5):610-2; discussion 612. doi:
10.1016/j.surneu.2007.10.035. Epub 2008 Mar 4. PubMed PMID: 18291481.


40: Belverud S, Mogilner A, Schulder M. Intrathecal pumps. Neurotherapeutics.
2008 Jan;5(1):114-22. doi: 10.1016/j.nurt.2007.10.070. Review. PubMed PMID:
18164490; PubMed Central PMCID: PMC5084133.


41: Greenfield JP, Schwartz TH. Catheter placement for Ommaya reservoirs with
frameless surgical navigation: technical note. Stereotact Funct Neurosurg.
2008;86(2):101-5. Epub 2007 Dec 12. PubMed PMID: 18073523.


42: Rainov NG, Heidecke V. Management of chronic back and leg pain by intrathecal
drug delivery. Acta Neurochir Suppl. 2007;97(Pt 1):49-56. Review. PubMed PMID:
17691356.


43: Fulkerson DH, Boaz JC, Luerssen TG. Interaction of ventriculoperitoneal shunt
and baclofen pump. Childs Nerv Syst. 2007 Jul;23(7):733-8. Epub 2007 Mar 16.
PubMed PMID: 17364210.


44: Miele VJ, Price K, Bloomfield S, Hogg J, Bailes J. Intrathecal morphine
therapy related granulomas: two case reports. W V Med J. 2006
Sep-Oct;102(5):16-8. PubMed PMID: 17285949.


45: McCall TD, MacDonald JD. Cervical catheter tip placement for intrathecal
baclofen administration. Neurosurgery. 2006 Sep;59(3):634-40; discussion 634-40. 
PubMed PMID: 16955045.


46: Lehmberg J, Scheiwe C, Spreer J, van Velthoven V. Late bacterial granuloma at
an intrathecal drug delivery catheter. Acta Neurochir (Wien). 2006
Aug;148(8):899-901; discussion 901. Epub 2006 Jun 23. PubMed PMID: 16791432.


47: Douglas AF, Weiner HL, Schwartz DR. Prolonged intrathecal baclofen withdrawal
syndrome. Case report and discussion of current therapeutic management. J
Neurosurg. 2005 Jun;102(6):1133-6. Review. PubMed PMID: 16028775.


48: Lew SM, Psaty EL, Abbott R. An unusual cause of overdose after baclofen pump 
implantation: case report. Neurosurgery. 2005 Mar;56(3):E624; discussion E624.
PubMed PMID: 15730591.


49: Dario A, Scamoni C, Picano M, Fortini G, Cuffari S, Tomei G. The infection
risk of intrathecal drug infusion pumps after multiple refill procedures.
Neuromodulation. 2005 Jan;8(1):36-9. doi: 10.1111/j.1094-7159.2005.05218.x.
PubMed PMID: 22151381.


50: Follett KA, Boortz-Marx RL, Drake JM, DuPen S, Schneider SJ, Turner MS,
Coffey RJ. Prevention and management of intrathecal drug delivery and spinal cord
stimulation system infections. Anesthesiology. 2004 Jun;100(6):1582-94. Review.
PubMed PMID: 15166581.


51: Hunter TB, Yoshino MT, Dzioba RB, Light RA, Berger WG. Medical devices of the
head, neck, and spine. Radiographics. 2004 Jan-Feb;24(1):257-85. Review. Erratum 
in: Radiographics. 2004 Mar-Apr;24(2):418. PubMed PMID: 14730051.


52: Penn RD. Intrathecal medication delivery. Neurosurg Clin N Am. 2003
Jul;14(3):381-7. Review. PubMed PMID: 14567139.


53: Simpson RK Jr. Mechanisms of action of intrathecal medications. Neurosurg
Clin N Am. 2003 Jul;14(3):353-64. Review. PubMed PMID: 14567137.


54: Turner MS. Intrathecal drug delivery 2002. Acta Neurochir Suppl.
2003;87:29-35. Review. PubMed PMID: 14518519.


55: Bergenheim AT, Wendelius M, Shahidi S, Larsson E. Spasticity in a child with 
myelomeningocele treated with continuous intrathecal baclofen. Pediatr Neurosurg.
2003 Oct;39(4):218-21. PubMed PMID: 12944705.


56: Dickerman RD, Stevens QE, Schneider SJ. The role of surgical placement and
pump orientation in intrathecal pump system failure: a technical report. Pediatr 
Neurosurg. 2003 Feb;38(2):107-9. PubMed PMID: 12566846.


57: Kumar K, Hunter G, Demeria DD. Treatment of chronic pain by using intrathecal
drug therapy compared with conventional pain therapies: a cost-effectiveness
analysis. J Neurosurg. 2002 Oct;97(4):803-10. PubMed PMID: 12405366.


58: Alden TD, Lytle RA, Park TS, Noetzel MJ, Ojemann JG. Intrathecal baclofen
withdrawal: a case report and review of the literature. Childs Nerv Syst. 2002
Oct;18(9-10):522-5. Epub 2002 Jul 23. Review. PubMed PMID: 12382179.


59: Dickerman RD, Schneider SJ. Recurrent intrathecal baclofen pump catheter
leakage: A surgical observation with recommendations. J Pediatr Surg. 2002
Jun;37(6):E17. PubMed PMID: 12037778.


60: Lordon SP. Interventional approach to cancer pain. Curr Pain Headache Rep.
2002 Jun;6(3):202-6. Review. PubMed PMID: 12003691.


61: Kopell BH, Sala D, Doyle WK, Feldman DS, Wisoff JH, Weiner HL. Subfascial
implantation of intrathecal baclofen pumps in children: technical note.
Neurosurgery. 2001 Sep;49(3):753-6; discussion 756-7. PubMed PMID: 11523691.


62: Kumar K, Kelly M, Pirlot T. Continuous intrathecal morphine treatment for
chronic pain of nonmalignant etiology: long-term benefits and efficacy. Surg
Neurol. 2001 Feb;55(2):79-86; discussion 86-8. PubMed PMID: 11301086.


63: Al-Anazi A, Bernstein M. Modified stereotactic insertion of the Ommaya
reservoir. Technical note. J Neurosurg. 2000 Jun;92(6):1050-2. PubMed PMID:
10839270.


64: Van Schaeybroeck P, Nuttin B, Lagae L, Schrijvers E, Borghgraef C, Feys P.
Intrathecal baclofen for intractable cerebral spasticity: a prospective
placebo-controlled, double-blind study. Neurosurgery. 2000 Mar;46(3):603-9;
discussion 609-12. PubMed PMID: 10719857.


65: Hassenbusch SJ. Cost modeling for alternate routes of administration of
opioids for cancer pain. Oncology (Williston Park). 1999 May;13(5 Suppl 2):63-7. 
PubMed PMID: 10356701.


66: Naumann C, Erdine S, Koulousakis A, Van Buyten JP, Schuchard M. Drug adverse 
events and system complications of intrathecal opioid delivery for pain: origins,
detection, manifestations, and management. Neuromodulation. 1999 Apr;2(2):92-107.
doi: 10.1046/j.1525-1403.1999.00092.x. PubMed PMID: 22151113.


67: Anderson VC, Burchiel KJ. A prospective study of long-term intrathecal
morphine in the management of chronic nonmalignant pain. Neurosurgery. 1999
Feb;44(2):289-300; discussion 300-1. PubMed PMID: 9932882.


68: Gianino JM, York MM, Paice JA, Shott S. Quality of life: effect of reduced
spasticity from intrathecal baclofen. J Neurosci Nurs. 1998 Feb;30(1):47-54.
PubMed PMID: 9604822.


69: Cabbell KL, Taren JA, Sagher O. Spinal cord compression by catheter
granulomas in high-dose intrathecal morphine therapy: case report. Neurosurgery. 
1998 May;42(5):1176-80; discussion 1180-1. Review. PubMed PMID: 9588567.


70: Kawashima A, Kasuya H, Shiokawa K, Miyajima M, Izawa M, Takakura K. [Efficacy
of nicardipine prolonged-release pellet on cerebral vasospasm in dogs]. No
Shinkei Geka. 1998 Jan;26(1):37-43. Japanese. PubMed PMID: 9488990.


71: Angel IF, Gould HJ Jr, Carey ME. Intrathecal morphine pump as a treatment
option in chronic pain of nonmalignant origin. Surg Neurol. 1998 Jan;49(1):92-8; 
discussion 98-9. PubMed PMID: 9428901.


72: Penn RD, Kroin JS, York MM, Cedarbaum JM. Intrathecal ciliary neurotrophic
factor delivery for treatment of amyotrophic lateral sclerosis (phase I trial).
Neurosurgery. 1997 Jan;40(1):94-9; discussion 99-100. PubMed PMID: 8971830.


73: Penn RD, York MM, Paice JA. Catheter systems for intrathecal drug delivery. J
Neurosurg. 1995 Aug;83(2):215-7. PubMed PMID: 7616263.


74: Estebe JP, Le Corre P, Mallédant Y, Chevanne F, Leverge R. Prolongation of
spinal anesthesia with bupivacaine-loaded (DL-lactide) microspheres. Anesth
Analg. 1995 Jul;81(1):99-103. PubMed PMID: 7598291.


75: Pratt K, Toombs JP, Widmer WR, Borgens RB. Plasma and cerebrospinal fluid
concentrations of 4-aminopyridine following intravenous injection and metered
intrathecal delivery in canines. J Neurotrauma. 1995 Feb;12(1):23-39. PubMed
PMID: 7783231.


76: Gianino J. Intrathecal baclofen for spinal spasticity: implications for
nursing practice. J Neurosci Nurs. 1993 Aug;25(4):254-64. Review. PubMed PMID:
8228399.


77: Schultheiss R, Schramm J, Neidhardt J. Dose changes in long- and medium-term 
intrathecal morphine therapy of cancer pain. Neurosurgery. 1992 Oct;31(4):664-9; 
discussion 669-70. PubMed PMID: 1383867.


78: Penn RD. Intrathecal baclofen for spasticity of spinal origin: seven years of
experience. J Neurosurg. 1992 Aug;77(2):236-40. PubMed PMID: 1625011.


79: Erickson DL, Lo J, Michaelson M. Control of intractable spasticity with
intrathecal morphine sulfate. Neurosurgery. 1989 Feb;24(2):236-8. PubMed PMID:
2918974.


80: Siegfried J. Electrostimulation and neurosurgical measures in cancer pain.
Recent Results Cancer Res. 1988;108:28-32. Review. PubMed PMID: 3051206.


81: Brazenor GA. Long term intrathecal administration of morphine: a comparison
of bolus injection via reservoir with continuous infusion by implanted pump.
Neurosurgery. 1987 Oct;21(4):484-91. PubMed PMID: 3683781.