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Orthopedic surgery in children with intrathecal baclofen pumps
Judith L Gooch1, Molly McFadden2, Wende Oberg3
1Utah Neuro Rehabilitation, Salt Lake City, UT, USA.
Insights
Early intrathecal baclofen pump (ITB) implantation in children with cerebral palsy did not reduce overall orthopedic surgeries. However, ITB therapy was associated with a lower hazard of scoliosis surgery.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Children with cerebral palsy (CP) frequently experience severe spasticity, leading to deformities and numerous orthopedic surgeries.
- Intrathecal baclofen pump (ITB) implantation is an effective treatment for severe spasticity in this population.
Purpose of the Study:
- To investigate if early ITB pump implantation in children with CP leads to fewer orthopedic surgeries compared to later implantation.
- To analyze the impact of ITB therapy timing on the frequency of orthopedic interventions.
Main Methods:
- Retrospective study involving 310 children with CP.
- Survival analysis was used to compare surgery occurrence based on ITB pump status (presence/absence).
- The baclofen pump was modeled as a time-dependent variable with age as the time scale.
Main Results:
- No significant difference in overall orthopedic surgery frequency was observed between children with and without ITB pumps.
- Children without an ITB pump had a 64% lower hazard of undergoing scoliosis surgery.
Conclusions:
- The study found no evidence that early ITB pump implantation reduces the overall need for orthopedic surgeries in children with CP.
- While ITB therapy did not impact overall surgery rates, it was linked to a reduced risk of scoliosis surgery.
Aims:
Children with cerebral palsy often have severe spasticity leading to deformity that requires multiple orthopedic surgeries. Intrathecal baclofen pump implantation effectively decreases severe spasticity. The objective of this study was to determine whether children who have a baclofen pump implanted at a young age have fewer orthopedic surgeries than those who have a baclofen pump implanted at later ages.
Methods:
In this retrospective study of 310 children, we compared occurrence of surgery in relation to having or not having the baclofen pump, by using survival analysis with surgery as the outcome, presence of baclofen pump as the exposure of interest, modeled as a time-dependent variable, and age as the time scale.
Results:
There was no significant effect of pump placement on overall surgery frequency. Analyses by type of surgery showed that those without a pump in place had a 64% lower hazard of scoliosis surgery.
Conclusions:
No evidence was found to indicate that children who have a baclofen pump implanted at a young age have fewer orthopedic surgeries than those who have a baclofen pump implanted at later ages.
