• Akara Forsythe, Anita Gupta, and Steven P Cohen.
• Department of Anesthesiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
• Reg Anesth Pain Med. 2009 Jul 1; 34 (4): 375-8.

Background And ObjectivesThe placement of lumbar spinal drains is being done with increasing frequency to facilitate high-risk surgical procedures. One risk associated with these procedures is catheter shearing, resulting in a retained foreign body in the intrathecal space. Unlike retained epidural fragments, there are no guidelines on the management of this complication. The purpose of this article was to synthesize the literature on this subject to come up with guidelines for preventing and managing this complication.MethodsCase report and review of all published cases.ResultsMost cases of retained catheters are associated with difficulty inserting or advancing the catheter. Among those cases treated conservatively, approximately one third of patients developed symptoms. Factors that must be considered when weighing the decision to surgically remove the retained catheter include patient comorbidities and desires, size and location of the fragment, infectious risk, the presence of neurologic symptoms, and scheduled surgical procedure.ConclusionsA retained intrathecal catheter can be managed conservatively in certain contexts. Periodic follow-up visits, with or without repeat imaging, are recommended in these circumstances.

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