Outcomes of Posterior Spinal Fusion and Instrumentation in Patients With Continuous Intrathecal Baclofen Infusion Pumps

Abstract

CP patients with baclofen pumps who underwent spinal fusion had more complications compared with similar patients without pumps. There was no significant difference in surgical correction between matched pairs. Physicians and families should be aware of the increased risks of reoperation and rehospitalization after spinal fusion in the presence of baclofen pumps.

The management of scoliosis in children with cerebral palsy: a review

“…The effect of an ITB pump at the time of scoliosis surgery is also controversial. There is an increase in the risk of infection, re-operation and re-hospitalization when compared to matched controls undergoing the same procedure (34). However, in another study by Borowski et al (35) the insertion of ITB pumps before, during or after posterior spinal fusion had no significant effect on outcome.…”

Perioperative complications associated with spine surgery in patients with established spinal cord injury

“…These intrathecal devices can be very difficult to work around during an extensive surgery. Caird et al [59] reported on the complication rate of posterior spinal fusion and instrumentation in patients with intrathecal baclofen pumps and found a 45% complication rate related to the pump during or after spinal fusion. Most complications are related to repeat spine surgery, such as wound infections; however, cases of dural tear, pump displacement, and tubing damage can cause significant problems.…”

Scoliosis, Spinal Fusion, and Intrathecal Baclofen Pump Implantation

“…There are 2 studies that have compared the outcomes of PSF in CP with and without ITB pumps. 38,45 Caird and colleagues 45 compared 20 patients with spastic quadriplegic CP with ITB pump who underwent PSF with 20 matched patients without an ITB pump. They found increased reoperation and rehospitalization, as mentioned previously, and a higher infection rate in the ITB pump group (20% vs 0%; P 5 .063).…”

“…Similar to infections, the complications related to catheters and pumps are a common reason for rehospitalization and reoperation. 45 An additional complication reported with ITB pump placement before scoliosis surgery is progression of scoliosis. Significant controversy exists as to whether insertion of ITB pumps causes progression of scoliosis in patients with CP, [46][47][48][49][50][51][52] and some clinicians think that the progression is related to patients who receive an ITB pump being more severely involved and thus their natural history is to have progressive scoliosis.…”