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Spinal catheter revision in pediatric intrathecal baclofen pumps: risk factors and postoperative outcomes
Amanda M Mosher1, Emma Hartman1, Dylan Keusch1
11Department of Neurosurgery and.
Insights
Younger age and increased spasticity in cerebral palsy patients increase the risk of intrathecal baclofen (ITB) pump catheter malfunction. This can lead to higher infection rates and ITB system removal, necessitating further study of catheter patency.
Area of Science:
- Neurology
- Pediatric Surgery
- Biomedical Engineering
Background:
- Intrathecal baclofen (ITB) pumps are crucial for managing spasticity in pediatric cerebral palsy (CP).
- Spinal catheter malfunction is a significant complication, but its risk factors and consequences are not fully understood.
Purpose of the Study:
- To identify risk factors for spinal catheter malfunction in ITB pumps.
- To characterize the clinical outcomes following ITB pump revision or replacement.
Main Methods:
- Retrospective review of pediatric patients undergoing ITB pump procedures (2010-2023).
- Comparison of patients requiring spinal catheter revision (SCRC) versus those with abdominal pump replacement only (APRC).
- Multivariable regression analysis to determine factors associated with catheter revision and outcomes.
Main Results:
- Younger age and higher preoperative lower-extremity tone (Modified Ashworth Scale) were linked to spinal catheter revision.
- Spinal catheter revision was associated with increased postoperative infection rates (17.1% vs 0%) and higher rates of subsequent ITB system removal (24.4% vs 7.4%).
- Postoperative ITB doses were lower in the SCRC group, and 31.7% of revisions were unanticipated.
Conclusions:
- Younger age and increased spasticity are potential risk factors for ITB spinal catheter obstruction.
- Catheter obstruction leads to increased infection risk, ITB system removal, and potentially suboptimal tone management.
- Routine assessment of catheter patency may be warranted to prevent complications from insidious catheter malfunction.
Objective:
Intrathecal baclofen (ITB) pumps are commonly used in pediatric patients with cerebral palsy (CP) and medically refractory spasticity. However, catheter malfunction and associated risk factors are not well understood. The aim of this study was to examine potential risk factors for spinal catheter malfunction and characterize postoperative follow-up to understand the clinical consequences.
Methods:
Patients who received ITB pump replacement or revision at Boston Children's Hospital between 2010 and 2023 were retrospectively reviewed. The spinal catheter revision cohort (SCRC) included patients whose spinal catheter was occluded requiring lumbar catheter revision. The second cohort included abdominal pump replacements only (APRC). Between-group comparisons and multivariable regression identified factors associated with catheter revision and postoperative outcomes.
Results:
Forty-one (33.6%) patients underwent spinal catheter revision and were compared with 81 patients (66.4%) who underwent abdominal pump replacement only. Younger age at surgery and an elevated preoperative lower-extremity modified Ashworth scale grade were associated with spinal catheter revision (p < 0.05). Catheter model type, tip location, and history of spinal fusion were not associated with obstruction. Postoperatively, SCRC patients experienced a higher rate of infection (17.1%) relative to APRC patients (0%) within 30 days from their ITB pump replacement procedure (p < 0.05) and greater likelihood of subsequent ITB system removal compared with the APRC (24.4% vs 7.4%, p < 0.05). Although not differing preoperatively, SCRC patients had lower postoperative ITB doses when compared with the APRC group (median dose 143 vs 350 µg/day, p < 0.05) at hospital discharge and remained statistically different at the 6-month and 1-year follow-ups (p < 0.05). There were no postoperative differences in baclofen overdose, withdrawal, or median number of hospital readmissions within 30 days. Overall, 31.7% of spinal catheter revisions were unanticipated by the clinical team at time of surgery.
Conclusions:
Younger age at surgery and increased preoperative lower-extremity tone may be risk factors for catheter obstruction, resulting in a higher rate of postoperative infection and subsequent ITB pump removal compared with pump replacement alone. Spinal catheter occlusion can complicate revision or replacement procedures, especially when unanticipated. Routine clinical assessment may be inadequate for diagnosing insidious catheter malfunction. Catheter occlusion deserves further study, and routine assessment of catheter patency may be warranted to prevent suboptimal tone therapy.
