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Spinal cord stimulation and intrathecal baclofen therapy for patients with severe spasticity after spinal cord injury
Artur Biktimirov1, Igor Bryukhovetskiy2, Aruna Sharma3
1Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia; Department of Neurosurgery, Far Eastern Federal University, Medical Center, Vladivostok, Russia; Far Eastern Federal University, National Technological Initiative (NTI) Center for Neurotechnology, Virtual and Augmented Reality Technologies, Vladivostok, Russia.
Rationale:
Spasticity is one of the main complications after the spinal cord injury (SCI). Most commonly, severe cases of spasticity are treated surgically with intrathecal baclofen therapy (ITB). Spinal cord stimulation for chronic pains (SCS) serves as an alternative for ITB. Both methods have their benefits and limitations. This study is aimed at development of a personalized SCS and ITB treatment algorithm for patients with severe cases of spasticity after SCI.
Materials And Methods:
The paper analyzes the treatment results of 66 patients with severe spasticity after SCI (50 men and 16 women, age ranging from 18 to 62), average age is 36.03±12.29 y.o. Patients who chose surgery as a spasticity treatment option, received experimental stimulation, and after muscle tone reduction to a comfort level they were surgically implanted with a SCS system for chronic pain management. Patients with negative response to experimental stimulation were tested for baclofen and, based on the results, had a baclofen pump implanted. The patients were examined after 1, 3, 6 and 12 months.
Results:
Surgical implantation of a SCS system was performed for 18 patients, ITB was used for 15 patients. After first 3 months of observation both groups demonstrated a significant improvement of spasticity index, but the SCS patients had better results. However, 6 months later the MAS scores, frequency of spasms and reflexes in both groups were the same. After 12 months of observation the ITB group exhibited a significant improvement of the MAS scores, compared with the control group, and reached the results, similar to the SCS group.
Conclusions:
Surgical treatment of patients with severe spasticity after SCI should start with experimental spinal cord stimulation, and, in case of a positive response, be followed by SCS system implantation. Patients with positive response to the experimental stimulation exhibit a significantly prolonged response to treatment, without substantial differences from ITB patients.
