Externalization of Intrathecal Baclofen Pumps Using a Shoulder Sling: Technique and Clinical Outcomes

Background: Intrathecal baclofen (ITB) therapy is an established treatment for severe spasticity refractory to oral medications. Infection of the pump pocket remains a major complication, often requiring device removal and risking life-threatening baclofen withdrawal. Externalization of the pump allows continuation of therapy during infection management; however, traditional abdominal externalization techniques are uncomfortable, unstable, and prone to complications. Objective: To describe a novel axillary shoulder-sling technique for externalizing the ITB pump and to report its clinical outcomes in a cohort of patients requiring temporary pump removal for infection management. Methods: We retrospectively reviewed 14 patients who underwent ITB pump externalization using the axillary sling technique between January 2020 and March 2025. The procedure involved tunneling a new catheter subcutaneously from the lumbar region to the mid-axillary line and securing the pump within a sterile orthopedic stockinette loop positioned beneath the armpit. Pumps were maintained in the sling for approximately two months, with weekly sterile sling changes and continuous baclofen infusion. Results: The median age of patients was 52 years (IQR: 38–69), with an equal male-to-female distribution. Hypertension and diabetes were the most frequent comorbidities (36% each). All pumps remained externalized for a median of two months without a single incident of disconnection, infection recurrence, or exacerbation of spasticity. Every patient achieved complete resolution of infection and successful pump reimplantation. Patients reported improved comfort, more effortless mobility, and enhanced psychological well-being compared with prior abdominal placements. Conclusion: Axillary externalization of the ITB pump using a shoulder sling offers a secure, comfortable, and effective strategy for maintaining continuous baclofen delivery during infection management. This technique minimizes withdrawal risk, enhances patient mobility, and facilitates infection control. It represents a practical, reproducible approach that can be readily adopted in neurosurgical practice and warrants further prospective validation.