Intrathecal Baclofen Therapy Prior to Spinal Fusion for Patients With Gross Motor Function Classification System IV-V...

Area of Science:

• Neurosurgery
• Pediatric Orthopedics
• Rehabilitation Medicine

Background:

• Patients with Gross Motor Function Classification System (GMFCS) IV-V cerebral palsy (CP) often experience severe spasticity and develop scoliosis.
• Intrathecal baclofen (ITB) therapy is a recognized treatment for managing spasticity in this population.
• The impact of ITB on the recovery process after spinal fusion surgery for scoliosis in GMFCS IV-V CP patients remains under-explored.

Purpose of the Study:

• To evaluate the effect of ITB therapy on the postoperative recovery of patients with GMFCS IV-V CP undergoing spinal fusion for scoliosis.
• To compare complication rates, length of stay, pain scores, and medication usage between patients with and without ITB therapy.

Main Methods:

• Retrospective review of health records for patients with GMFCS IV-V CP who underwent spinal fusion for scoliosis between January 2009 and October 2015.
• Data abstraction included demographic information, operative characteristics, postoperative recovery metrics, and complication data.
• Statistical analysis using descriptive statistics and regression models to compare outcomes between patients with ITB therapy and those without.

Main Results:

• Sixty-nine patients were analyzed (19 with ITB, 50 without ITB), with similar demographic and operative characteristics.
• No significant differences were observed in the length of hospital stay (11.2 vs. 14.3 days, p = .12) or pain score reduction rates (p = .32) between the groups.
• A significantly lower incidence of complications was found in the ITB therapy group (21%) compared to the no ITB group (56%, p = .01), with fewer average complications per patient (0.3 vs. 1.1, p = .01).

Conclusions:

• Intrathecal baclofen (ITB) therapy does not significantly alter the length of stay, pain scores, or the use of pain/spasticity medications following spinal fusion in GMFCS IV-V CP patients.
• ITB therapy is associated with a significantly reduced incidence and number of postoperative complications in this patient cohort.
• These findings suggest that ITB may offer a protective benefit against postoperative complications in GMFCS IV-V CP patients undergoing spinal fusion for scoliosis.