Background Intrathecal baclofen (ITB) therapy effectively manages severe spasticity. While mechanical complications typically cause therapy loss or withdrawal, structural disruptions can remain completely occult due to anatomical adaptations. This report explores the unique management of an incidentally discovered catheter transection during routine reservoir exchange.Case presentation A female patient in her 30s with cerebral palsy had been treated with ITB since 2011 without functional complaint, despite sluggish cerebrospinal fluid (CSF) flow noted at a 2019 pump exchange that did not prompt catheter revision. After relocating out of state, the patient returned in 2025 for a planned pump reservoir replacement, reporting no interval decline. Preoperative catheter port myelography was not successful due to failure of CSF aspiration from the catheter access port, and intraoperative exploration revealed the catheter was completely fractured at its fascial insertion point, despite the reported years of clinical stability. Fragment retrieval required partial laminectomy and multilayer dural repair; after new hardware placement and retitration, her therapeutic outcome improved dramatically.Conclusions Subjective clinical efficacy is an unreliable proxy for system patency. Aging hardware configurations require proactive radiographic monitoring and targeted surgical revision to minimize the risk of withdrawal.
