Intrathecal drug delivery systems: A case series advancing surgical, clinical, and technological safety with broader implications for invasive neuromodulation therapies
Abstract
Intrathecal drug delivery systems (IDDS) represent an advanced modality of invasive pharmacological neuromodulation, providing efficacious treatment for terminal malignant pain as well as select chronic noncancer pain conditions. Although intrathecal drug delivery systems offer the potential for reduced systemic adverse effects compared to conventional routes, they are not without significant complications, including infections, device dysfunction, and severe neurological injuries. Moreover, the integration of network-based smart-device applications into intrathecal drug delivery system control interfaces introduces a concomitant elevation in risks associated with software errors and cybersecurity vulnerabilities. Case 1: a 77-year-old male receiving intrathecal methadone therapy, after the failure of first- and second-line agents, developed a catheter-tip spinal granuloma resulting in irreversible paraplegia secondary to thoracic spinal cord compression. Case 2: a 37-year-old female with a history of longstanding depression experienced a severe surgical site infection attributable to suboptimal surgical techniques during intrathecal drug delivery system implantation. This complication led to septic shock and meningitis, necessitating device removal and prolonged intravenous antibiotic therapy, though she ultimately recovered without permanent neurological deficits. Case 3: a 67-year-old female encountered acute opioid withdrawal and subsequent hospitalization as a…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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