Intrathecal Drug Delivery by Implanted Pumps

Direct central neural axis neuromodulation has become a viable means to treat chronic neurologic disease and injury. Although first described in 1898, technology has only recently allowed for strict modulation and adjustments of drug delivery into the centeral nervous system. Evolving congruently with understanding of the altered neurophysiology and an expanding pharmacologic armamentarium, intrathecal pump systems augment treatment in an ever expanding number of disorders. In this review, we present a general historical overview of direct neuroaxis delivery and discuss current indications for intrathecal delivery with considerations in patient and drug selection. Complications, both surgical and medical, are discussed in detail with focus on avoidance and management.