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Posterior cervical approach for intrathecal baclofen pump insertion in children with previous spinal fusions.
1Department of Neurosurgery, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City, Utah 84113, USA.
Insights
Intrathecal baclofen pumps manage spasticity in cerebral palsy. A posterior cervical approach offers a safe alternative for pump insertion when lumbar access is blocked by prior scoliosis surgery.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Intrathecal baclofen pumps are increasingly used for severe spasticity in children with cerebral palsy.
- Traditional lumbar catheter insertion can be challenging in patients with prior thoracolumbar fusions for scoliosis.
Observation:
- This study evaluated a posterior cervical approach for intrathecal baclofen pump insertion in three pediatric patients with spastic quadriplegic cerebral palsy and previous thoracolumbar fusions.
- The posterior cervical approach was successfully utilized in all three cases.
Findings:
- No complications such as catheter disconnection, dislodgement, or cerebrospinal fluid leakage were observed.
- Postoperative follow-up ranged from 10 to 28 months, with a mean of 17 months.
Implications:
- The posterior cervical approach is a safe and effective alternative for intrathecal baclofen pump insertion in pediatric patients with cerebral palsy who have undergone prior thoracolumbar spine fusion.
- This technique expands treatment options for managing severe spasticity in complex pediatric cases.
Abstract:
Intrathecal baclofen pumps for the management of severe spasticity are being used more often in children with cerebral palsy. The intrathecal catheter is traditionally introduced dorsally in the lumbar region. In some children with previous thoracolumbar fusions for scoliosis, the fusion mass obviates the introduction of the intrathecal catheter. The authors describe their experience with a posterior cervical approach for intrathecal baclofen pump insertion in three patients with spastic quadriplegic cerebral palsy who had previously undergone thoracolumbar fusions for scoliosis. Insertion was successful in all three patients; no complications of catheter disconnection, catheter dislodgment, or cerebrospinal fluid leakage occurred. Follow-up review ranged from 10 to 28 months postoperatively (mean 17 months). The posterior cervical approach for intrathecal baclofen pump insertion is a safe and effective alternative for patients who have previously undergone thoracolumbar spine fusions and in whom the traditional lumbar approach is not feasible.
