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Does the Addition of Intrathecal Baclofen Along with or After Soft-Tissue Hip Adductor Surgery Decrease the Need for
Ali Asma1,2, Armagan Can Ulusaloglu1,2, Jason J Howard1,2
1Department of Orthopaedics, Nemours Children's Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE 19803 USA.
Insights
Intrathecal baclofen (ITB) combined with soft-tissue release for cerebral palsy (CP) spasticity did not decrease subsequent hip surgery needs. However, it did raise the risk of surgical site infections in CP patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Neurology
Background:
- Cerebral palsy (CP) spasticity often necessitates interventions like soft-tissue release.
- Intrathecal baclofen (ITB) is a common treatment for managing spasticity in CP.
- Combining soft-tissue release with ITB is a frequent approach for CP spasticity.
Purpose of the Study:
- To compare hip surgery outcomes in nonambulatory CP patients.
- To evaluate the efficacy of soft-tissue release before, during, or without ITB.
- To assess the impact of ITB timing on hip surgery and complications.
Main Methods:
- Retrospective study comparing three groups: soft-tissue release before ITB (PRE-ITB), simultaneous soft-tissue release and ITB (ST-ITB), and soft-tissue release without ITB (NON-ITB).
- Inclusion criteria: nonambulatory CP, prior adductor surgery, no prior reconstructive surgery, and ≥5-year follow-up.
- Primary outcomes: subsequent hip surgery and hip migration (≥50% defined as unsuccessful).
Main Results:
- Mean follow-up was approximately 9.3 years across groups.
- The ST-ITB group showed lower odds of unsuccessful hips compared to NON-ITB and PRE-ITB.
- However, ST-ITB had significantly higher rates of subsequent osteotomies or revision adductor surgery and surgical site infections compared to PRE-ITB and NON-ITB.
Conclusions:
- Adding ITB to soft-tissue release for CP spasticity did not reduce the need for later hip surgery.
- Simultaneous ITB and soft-tissue release increased the risk of surgical site infections.
- The timing of ITB in relation to soft-tissue release impacts surgical outcomes and complication rates.
Purpose:
Intrathecal baclofen (ITB) is a well-known treatment option for cerebral palsy (CP) spasticity. The combination of soft-tissue release and ITB for spasticity is common. This study compared patients who had soft-tissue release before ITB (PRE-ITB), soft-tissue release at the same time as ITB (ST-ITB), and no ITB (NON-ITB) but had soft-tissue release at a similar age as PRE-ITB.
Methods:
Inclusion criteria were a spastic or mixed nonambulatory CP diagnosis, prior hip adductor surgery, no prior reconstructive surgery, and at least a five-year post-operative follow-up. Thirty hips were identified as PRE-ITB, 20 hips as ST-ITB, and 43 hips as NON-ITB. The primary outcome variables were the subsequent hip surgery during the study period and/or a migration percentage ≥ 50% at the final follow-up defined as "unsuccessful hip."
Results:
The mean follow-up duration was 9.0 years (SD 2.4) for PRE-ITB, 9.4 (SD 3.6) for ST-ITB, and 9.3 (SD 3) for NON-ITB. The odds of unsuccessful outcomes were not different between NON-ITB and PRE-ITB but were lower for the ST-ITB group. The need for subsequent osteotomies or revision adductor surgery was significantly higher in ST-ITB compared with PRE-ITB (p = 0.02) or NON-ITB (p = 0.015). The incidence of surgical site infection over the whole follow-up period was higher in ST-ITB (40%) compared with PRE-ITB (13.3%, p = 0.035) and NON-ITB (0, p < 0.001).
Conclusion:
The addition of tone management with ITB did not reduce the need for later hip surgery but did increase the risk for surgical site infection.
