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Does intrathecal baclofen therapy decrease the progression of hip displacement in young patients with cerebral palsy?
Ali Asma1, Armagan Can Ulusaloglu1, Jason J Howard1
1Department of Orthopedic Surgery, Nemours Children's Health, Delaware, USA.
Insights
Intrathecal baclofen pump (ITBP) therapy did not change hip dysplasia progression in young patients with cerebral palsy (CP). Hip displacement in CP is multifactorial, not solely due to spasticity.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) often leads to hip dysplasia, particularly in severe motor impairments (GMFCS IV-V).
- Intrathecal baclofen pump (ITBP) therapy is used to manage spasticity in CP.
- The impact of ITBP on the natural history of hip displacement in CP remains unclear.
Purpose of the Study:
- To evaluate the effect of ITBP therapy on hip dysplasia progression in young patients with CP.
- To compare hip migration and surgical rates between CP patients with and without ITBP.
Main Methods:
- Retrospective cohort study of CP patients (GMFCS IV-V) under 8 years old with ITBP.
- Matched control group of 71 patients without ITBP.
- Minimum 5-year follow-up assessing hip migration percentage and hip surgery rates.
Main Results:
- No statistically significant difference in hip migration percentage at follow-up between ITBP and non-ITBP groups (36.2% vs 44.4%, p=0.14).
- Similar rates of future preventative, reconstructive, and recurrent hip surgeries in both groups.
- ITBP therapy did not alter the progression of hip displacement.
Conclusions:
- Early ITBP treatment for spasticity does not modify the natural course of hip displacement in non-ambulatory CP patients.
- Hip displacement in CP is likely multifactorial, with spasticity being only one contributing factor.
- Further research is needed to understand the complex etiology of hip dysplasia in CP.
Aim:
To evaluate the effects of intrathecal baclofen pump (ITBP) therapy on hip dysplasia in young patients with cerebral palsy (CP).
Method:
This was a retrospective cohort series of prospectively collected data. Inclusion criteria were all patients with CP in Gross Motor Function Classification System (GMFCS) levels IV or V who underwent ITBP placement under 8 years old with at least 5 years of follow-up. Thirty-four patients were matched to a control group of 71 patients based on GMFCS level, motor type, medical comorbidities, worst hip migration percentage at ITBP placement, age, and Modified Ashworth scale scores. Patients were followed for at least 5 years or until they had hip reconstructive surgery. The primary outcome was the development of hip displacement as measured by the migration percentage at the latest follow-up or the preoperative migration percentage before hip reconstruction.
Results:
The migration percentage at last follow-up was not statistically different between groups (ITBP: 36.2%, non-ITBP: 44.4%, p = 0.14). The rates of future preventative, reconstructive, and recurrent hip surgery were not different between groups.
Interpretation:
The use of ITBP as an early treatment of spasticity did not alter the natural history of progressive hip displacement in non-ambulatory patients with CP and hip displacement is likely multifactorial, not solely due to spasticity.
