Intrathecal baclofen therapy in spinal cord injury: Referral patterns, dosing trends, and long-term complications

This study investigates intrathecal baclofen (ITB) therapy referral timing, dosing patterns, and complications in individuals with spinal cord injury (SCI).

Retrospective chart review.

Outpatient clinic.

A total of 147 adults with SCI and spasticity who underwent ITB trials or therapy at our center between July 2013 and July 2023 were included. Data were collected to assess ITB trial outcomes, referral patterns, dosing trends, and ITB-related complications.

Of the 147 patients, 89% had traumatic SCI, 11% had nontraumatic SCI, and 79% were male, with a median age of 28 years (IQR: 21-44). The median Modified Ashworth Scale (MAS) score at referral was 3 (IQR: 3-3), and the Penn Spasm Frequency Scale (PSFS) score was 3 (IQR: 2-3). Nontraumatic SCI required higher median ITB doses than traumatic SCI (458 mcg vs. 300 mcg, p = 0.04). Additionally, individuals with AIS D required significantly lower doses (p < 0.001). The ITB-related complication rate was 27%, with pump site infections (13%) and catheter malfunctions (9%) being the most common. Despite complications, 82% of affected patients underwent successful pump re-implantation or catheter replacement.

Most ITB recipients are younger individuals with severe spasticity at referral. Dosing patterns vary by etiology and severity of injury. While ITB is effective, long-term monitoring is essential to mitigate ITB-related infections and catheter complications. Further research is needed to study risk factors for complications and evaluate long-term outcomes.