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Complications of intrathecal baclofen pumps in children
Judith L Gooch1, Wende A Oberg, Barbara Grams
1Primary Children's Medical Center, Salt Lake City, Utah 84113, USA. pcjgooch@ihc.com
Insights
Intrathecal baclofen pumps for severe spasticity in children can cause complications. Catheter disconnection and dislodgement were most common, especially with catheter access ports, leading to changes in implantation techniques.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Rehabilitation Medicine
Background:
- Intrathecal baclofen (ITB) is a key treatment for severe pediatric spasticity.
- While effective for tone reduction, ITB therapy is associated with potential complications.
- Understanding device-related issues is crucial for optimizing patient outcomes.
Purpose of the Study:
- To identify and analyze device- and non-device-related complications in pediatric patients receiving ITB pumps.
- To compare complication rates between ITB pumps with and without catheter access ports.
- To inform surgical technique modifications for reducing complication incidence.
Main Methods:
- Retrospective review of 117 ITB pump implantations in 100 pediatric patients.
- Detailed documentation of all device- and non-device-related complications.
- Analysis of complication types, frequency, and association with pump features (e.g., catheter access ports).
Main Results:
- 24% of patients (48 complications in 117 pumps) experienced issues.
- Catheter disconnection at the pump connection was the most frequent complication (9%), higher in pumps with access ports (16% vs 2%).
- Catheter dislodgement occurred in 8% of pumps, also more frequent with access ports (13% vs 4%).
Conclusions:
- Modifications in ITB pump implantation, such as using pumps without catheter access ports and 2-piece catheters, can decrease common complications.
- While access ports aid troubleshooting, their absence may reduce disconnection and dislodgement rates.
- Comprehensive patient and family education is vital to prevent severe baclofen withdrawal from catheter complications.
Abstract:
Intrathecal baclofen is increasingly being used to manage severe spasticity in children. Although substantial tone reduction with this treatment has been documented, complications also occur. In this study, we describe the device- and major non-device-related complications in a group of 100 consecutive children and young adults who received 117 intrathecal baclofen pumps for the management of severe spasticity. Twenty-four patients (24%) experienced a total of 48 complications. The most common complication was disconnection of the catheter at its connection to the pump, occurring in 9% of pumps implanted. This complication occurred more frequently in pumps with catheter access ports (16%) than in those without ports (2%). Catheter dislodgement from the intrathecal space was the next most common complication, occurring in 8% of pumps implanted (13% of pumps with ports, 4% of pumps without ports). To decrease the occurrence of the most common complications of intrathecal pumps, we now typically implant pumps without catheter access ports, and we use 2-piece catheters. Although the lack of an access port may be a disadvantage for troubleshooting, most complications can be detected in pumps without a port. Patient and family education is critical in preventing serious consequences of baclofen withdrawal resulting from catheter-related complications.