Identification of complications in paediatric cerebral palsy treated with intrathecal baclofen pump: A descriptive analysis of 15 years at one institution

Abstract

Purpose Intrathecal baclofen (ITB) treatment is used with increasing frequency in the cerebral palsy population. We describe the complications of ITB treatment, the incidence of complications, and our experience with their treatment. Methods In a period of 15 years, 341 paediatric patients with cerebral palsy treated with ITB were evaluated. Device problems associated with the catheter or pump, or infection and complications such as cerebrospinal fluid (CSF) leak and postdural spinal headache, were reviewed. Infection was classified as early (≤ 90 days) or late (> 90 days) according to the time of onset. Results The infection rate was 6.9% per procedure (50/720) and 14.6% per patient (50/341) over a mean 6.3 ± 3.9 years. There was a positive correlation between the risk of infection and preoperative comorbidities including epilepsy/seizure history, feeding tube, and mixed type cerebral palsy (p < 0.05, p = 0.03, p = 0.01, respectively). Eighty-five (24.9%) patients experienced 90 CSF leak episodes; 61 of these 85 patients had headache complaints as a result of CSF leak. There was a positive correlation between the risk of early infection and CSF leak (p < 0.05). Conclusions The most common complication related to ITB was associated with pump and catheter problems. The rate of complications with the use of ITB is relatively high; however, based on the literature reports, it is the most effective treatment for severe spasticity and dystonia in patients with severe cerebral palsy. Level of Evidence III

Surgical complications of intrathecal baclofen in children: A single centre, 20-year retrospective cohort study

“…8 Common complications of ITB are cerebrospinal fluid leakage, infection and catheter-related problems such as kinking and occlusion. [9][10][11][12][13] The number of complications described in literature varies widely (18%-44%). [9][10][11][12][13] Surgical implantation techniques and materials have improved over the past years including the introduction of a new type of catheter in 2012, a coated catheter (Ascenda® intrathecal catheter, model 8780, Medtronic Inc).…”

“…[9][10][11][12][13] The number of complications described in literature varies widely (18%-44%). [9][10][11][12][13] Surgical implantation techniques and materials have improved over the past years including the introduction of a new type of catheter in 2012, a coated catheter (Ascenda® intrathecal catheter, model 8780, Medtronic Inc). This catheter is made of silicone tubing which is covered by a thermoplastic polyethylene terephthalate braid and a polyurethane outer layer.…”

Is intrathecal baclofen an effective treatment for children with hereditary spastic paraparesis?

“…However, the use of ITB in children compared with adults does potentially pose additional risks. Notably, children may be at higher risk from overdosing on baclofen, having infections and requiring repeated surgeries to fix catheter problems which could have profound psychosocial implications alongside the risk of iatrogenic neurological injury 12 13. In a 15-year study of 341 children with cerebral palsy treated with ITB the overall complication rate was reported at 44%, most commonly involving the pump or catheter 13.…”

“…Notably, children may be at higher risk from overdosing on baclofen, having infections and requiring repeated surgeries to fix catheter problems which could have profound psychosocial implications alongside the risk of iatrogenic neurological injury 12 13. In a 15-year study of 341 children with cerebral palsy treated with ITB the overall complication rate was reported at 44%, most commonly involving the pump or catheter 13. Over the average pump life (6.3 years) cerebrospinal fluid leaks occurred in 25% of patients and wound/pump infections in 14.6% 13 14.…”

“…In a 15-year study of 341 children with cerebral palsy treated with ITB the overall complication rate was reported at 44%, most commonly involving the pump or catheter 13. Over the average pump life (6.3 years) cerebrospinal fluid leaks occurred in 25% of patients and wound/pump infections in 14.6% 13 14. Hence, complications do occur in a significant proportion of children treated with ITB.…”