Potential Complications of Posterior Spine Fusion and Instrumentation in Patients With Cerebral Palsy Treated With Intrathecal Baclofen Infusion

Abstract

Low pressure headaches resulting from a cerebrospinal fluid leak following catheter reinsertion may occur in the postoperative period. Preoperative concerns with the baclofen pump reservoir placed subcutaneously and pressure sores were not seen with careful prone positioning on a 4-poster frame. Progression of scoliosis in patients with cerebral palsy requiring spinal arthrodesis was demonstrated in 4 of the patients after continuous intrathecal baclofen was started. The progression of the spinal deformity as a consequence of growth, natural history, or the intrathecal baclofen infusion is unknown at the present time.

Do baclofen pumps influence the development of scoliosis in children?

“…A 4-year-old patient and a 19-year-old patient were the only truly notable cases because the patients' ages are considered outside of the growth spurt period. Segal et al 9 published a report of 5 patients who underwent spinal fusion following insertion of intrathecal baclofen pumps. The patients were between ages 12 and 20 years at the time of pump insertion, and the diagnosis was spastic quadriplegia cerebral palsy in all 5.…”

Although Inconvenient, Baclofen Pumps Do Not Complicate Scoliosis Surgery in Patients With Cerebral Palsy

“…0%), but this is likely multifactorial as more of the pediatric patients had a diagnosis of CP than the adult population. 13 , 14 Segal et al 13 initially presented their series of 5 patients with a mean progression of 44 ° over 11 months, leading to spinal fusion. In the setting of infection, there is a high removal rate of the catheter and pump.…”

Scoliosis, Spinal Fusion, and Intrathecal Baclofen Pump Implantation

“…8 Two series of patients reported accelerated scoliosis progression after ITB pump placement. 47,48 Segal and colleagues 47 initially presented their series of 5 patients with a mean progression of 44 over 11 months leading to spinal fusion. Burn and colleagues 50 found an annual progression of Cobb angle of 18 and an increase in progression per year in patients less than 15 years old at the time of ITB pump placement.…”

“…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. 8 Two series of patients reported accelerated scoliosis progression after ITB pump placement.…”