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Baclofen pump implantation and spinal fusion in children: techniques and complications
Andrzej Borowski1, Suken A Shah, Aaron G Littleton
1Department of Orthopedics, Alfred I duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE 19899, USA.
Insights
Intrathecal baclofen therapy (ITB) and posterior spine fusion (PSF) can be safely performed in patients with cerebral palsy. The order of these procedures does not increase complication rates for ITB or PSF.
Area of Science:
- Neurology
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Intrathecal baclofen therapy (ITB) is a common treatment for spasticity in children with cerebral palsy.
- This population frequently requires posterior spine fusion (PSF) for severe spinal deformities.
Purpose of the Study:
- To evaluate technical considerations and complications of ITB in patients undergoing PSF.
- To compare complication rates of ITB when performed before, during, or after PSF.
Main Methods:
- Retrospective review of clinical and radiographic data from 165 patients.
- Patients were divided into four groups: PSF before ITB, concurrent PSF and ITB, PSF after ITB, and ITB only (control).
- Complications and infections were analyzed using chi-squared tests.
Main Results:
- No statistically significant difference in infection or device/catheter complication rates was found among the four groups.
- Specific complication counts included catheter malfunctions, infections, and pump issues across all groups.
- The control group (ITB only) had the highest number of catheter malfunctions and pump failures.
Conclusions:
- Posterior spine fusion does not increase the complication rate of intrathecal baclofen therapy, regardless of the procedural order.
- Careful attention to technical details and catheter management is crucial for successful ITB pump implantation and management.
- ITB can be safely managed in conjunction with PSF, with appropriate surgical techniques.
Study Design:
Retrospective clinical and radiographic review of complications related to intrathecal baclofen therapy (ITB) and posterior spine fusion (PSF) in patients with cerebral palsy.
Objective:
To report the technical considerations and complications associated with ITB in patients undergoing PSF.
Summary Of Background Data:
A common treatment for spasticity in children with cerebral palsy is ITB. This population also has a high incidence of severe spinal deformities requiring PSF.
Methods:
There were 4 groups: A, 26 patients with PSF before ITB; B, 11 patients who underwent PSF and ITB concurrently; C, 25 patients with PSF after ITB; and D, the control group: 103 patients with ITB only. Complications and infections were tabulated from a retrospective chart review and ongoing surveillance data. Multiple chi analyses were used to compare the number of patients who experienced complications and infections among the groups. The operative sequence and catheter management techniques for the various scenarios are described in detail in the text.
Results:
The outcome by group was as follows: group A had 5 catheter malfunctions and 2 infections at the pump site, group B had 2 catheter malfunctions, 1 hypermobile pump and 1 infection at the spinal site, group C had 3 catheter malfunctions, 1 infection at the pump site and 1 infection at the spinal site. The control group had 23 catheter malfunctions, 5 pump failures, 8 infections at the pump site, and 1 infection at the spinal site. Multiple chi analyses showed no difference in the number of infection or device/catheter complications among any of the groups.
Conclusion:
The rate of ITB therapy complications is not increased despite PSF in any order of the procedures. There are technical details in each situation that require attention. With understanding of the appropriate techniques of catheter management, ITB pumps can be implanted and managed without an increased complication rate before, during or after spinal fusion surgery.
