Hey everybody!

For a fair portion of wheelchair users due to sustaining a spinal cord injury (SCI), especially the 67% or so whose SCI is determined ‘incomplete’, muscle spasms are a constant. The only things that are not are the severity, the consistency, and the painfulness of said spasms. So, what causes these spasms?

After a spinal cord injury, the normal flow of signals is disrupted, and the message does not reach the brain. Instead, the signals are sent back to the motor cells in the spinal cord and cause a reflex muscle spasm. This can result in a twitch, jerk or stiffening of the muscle. Spastic hypertonia, better known as spasticity, is one of the most common side effects of a spinal cord injury, with between 65% and 78% of spinal cord injury sufferers experiencing some degree of spasticity. Spasticity can make it more difficult to perform daily activities such as walking (I wish!), sitting, and sleeping.

Treatment for spasticity is varied. After my first SCI toward the end of 2006, I experienced quite a repeated occurrence of muscle spasticity, specifically in both calves, across my abdomen and lower back. I was initially prescribed baclofen in an oral form as a pill. I was taking 3x 30 mg 3 times/day. By 2009 I had reached a nadir with my oral baclofen medication. It minimised my spasticity, sure, but the side effects I experienced; headaches, drowsiness and lower blood pressure were a cause for concern. My pain management specialist Dr Rick Acland suggested an alternative, a Medtronic Intrathecal Baclofen pump. 

The Medtronic Intrathecal baclofen pump is part of the SynchroMed™ II programmable drug infusion system which provides precise drug delivery for chronic therapy for severe spasticity. In addition to the implanted pump, the SynchroMed™ II infusion system uses a catheter to deliver programmed amounts of Intrathecal baclofen directly to the intrathecal space and cerebrospinal fluid. The pump and catheter are implanted under the skin. The benefits of the Medtronic Intrathecal Baclofen pump to me are:

·       A flexible dosing schedule has allowed my drug delivery to be matched to my own particular needs, providing me with severe spasticity relief throughout the day.

·       Precise dosage enables pain management specialists to prescribe the lowest dose to reach my spasticity reduction goals.

By having the Medtronic Intrathecal baclofen pump implanted under the skin in my lower left abdominal wall my dosage has reduced from 3x 30mg 3 times/day to 0.425mcg/day pumped 24/7. This is the real game-changer!

The Medtronic Intrathecal baclofen pump has a battery life of 7 years meaning that 2023 was the year for the replacement of my second pump with my third by June of this year. Surgery was scheduled for Wednesday 10 May at 2.00 pm at Greenlane Hospital. So, a relatively easy drive, I was strapped into place in my Kuschall KSL wheelchair in the rear of my Mercedes Sprinter van driven by my partner, from the Hibiscus Coast to and over the Auckland Harbour Bridge and south to Greenlane Hospital was undertaken, with a check-in time of 1.00 pm achieved. A quick wheel to the lifts and then up to the surgical suites we went with masks firmly in place.

I had a lot of information to get through with one of the attending surgical nurses; full name, date of birth, NHI number plus a whole lot more. After what seemed like ages and ages the forms were completed, and it was time to change into those impossible to put on hospital gowns. Once the contortionist gymnastics required to fit the gown were completed it was briefing time from the anaesthetists on how the whole operation would be performed from their point of view. It was nothing I hadn’t heard before, type of anaesthesia, duration of operation, risks associated with it, time to be spent in recovery and then the fitting of an IV line. 

Now, this is always an issue with me when prepping for a general anaesthetic. For instance, my low blood pressure coupled with my state of dehydration, caused by the lack of liquid for the past 3 hours, means my veins were not particularly easily noticeable or large enough to accept an IV. So, after numerous attempts on more than one vein were butchered an IV was finally inserted. 

I was wheeled into the theatre, transferred onto the bed had a brief conversation with the anaesthetist who placed a mask over my nose and mouth. My next memory is waking up in the recovery room with many other patients all in our own curtained-off area. I didn’t feel any ill effects from the surgery, maybe a wee bit sleepy with a rasp in my throat from a tube being inserted during the surgery. On noticing I had awoken, a nurse approached and checked all my vitals; pulse, blood pressure and oxygen saturation level which was a tad bit low. After a number of deep, slow breaths this was rectified. I even received a lemon popsicle bar to suck on which helped with my throat.

I was visited by the pain management team who performed the surgery and explained the surgical procedure they had followed. They explained an incision was made in my lower left abdomen at the exact spot where a scar was from previous Medtronic pump surgery. This was to gain access to the pouch already created in the muscle wall lining where the old Medtronic pump was in situ. Once the old Medtronic pump was replaced in the pouch with the new one, the catheter that delivers the baclofen to and up the intrathecal channel was reconnected to the new Medtronic pump, and the procedure was done. The new Medtronic pump was then calibrated to deliver 0.425 mcg of baclofen 24/7 for the next seven years.

After a period of an hour or so spent in recovery, I was cleared to get dressed and leave Greenlane Hospital for home. My partner was on hand to assist me in dressing (top half only required thank goodness!), as the wound was understandably, somewhat tender. I was advised to treat the wound as simply a deep cut, to avoid any twisting or place any strain on the area for about a week. This meant no direct lift transfers but a move to sliding/banana board transfers instead. I was told to monitor the wound and not to get it wet for the next three days or so. 

The following day I noticed spots of blood showing through the dressing. I advised my pain management specialist who took it upon herself to make a house call to check the wound. On inspection, it was determined there was no issue with the wound, just post-operative weeping which was of no concern.

I am extremely happy to say that I have had no issue whatsoever with my new Medtronic Intrathecal Baclofen pump. It is performing as it should. The PTM (Patient Treatment Manager), remote I possess was also calibrated to the new Medtronic pump. This enables me to manually activate the Medtronic pump through the PTM to deliver a bolus of .50 mcg of baclofen if I sustain any sudden temporary increase in muscle spasticity. I am able to use this twice at a minimum of four hours apart every twenty-four hours.

To say I am happy with the whole surgical procedure would be a massive understatement and not do the Medtronic Intrathecal Baclofen pump justice. This pump has provided me with the opportunity to live my own life without the concerns I had and would have of any side effects from taking oral baclofen. There is no more scattergun attempt to minimise my muscle spasms, my muscle spasticity, but a targeted and minimalist process that provides me with the relief to allow me, as my Invacare supplied Kuschall KSL chair does and that is ‘to make experiences possible’.          

About the author

Ian Walker is a C6 Quadriplegic Incomplete. Ian lives in Christchurch, New Zealand and has survived 2 separate spinal cord injury-related accidents over the past 14 years. He is a Motivational Speaker who talks about - how to face adversity, cycle road safety, living with a disability, and being a 1 percenter . . .

Ian also enjoys life coaching which he utilises through his business BMotiv8d, to assist those with a disability, (or without), who lack motivation, direction and/or confidence, those who feel disorganised or unfulfilled, and/or those who need encouragement or need to set priorities, on how to realise their true potential.