Scoliosis, Spinal Fusion, and Intrathecal Baclofen Pump Implantation

Scannell, Brian P.; Yaszay, Burt

doi:10.1016/j.pmr.2014.09.003

Cited by 14 publications

(13 citation statements)

References 51 publications

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“…When the catheter reaches the desired level, the guide wire is removed, as well as the needle. 18 In our study, 22 patients died during the follow-up period corresponding to a mortality rate of 14%. In literature, this rate varies between 0 and 21%.…”

Section: Discussionmentioning

confidence: 63%

“…In literature, this rate varies between 0 and 21%. 18,20,21,26 This difference can be explained by the inclusion of different conditions and different follow-up times.…”

Section: Discussionmentioning

confidence: 99%

“…The test is positive if there is a 2 point reduction in the Ashworth or Modified Ashworth scale. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Possible complications of IPs are surgical (infection, dehiscence); intrinsic pump failure (mechanical or battery failure, migration, occlusion, fracture or disconnection of the catheter); and human error (overdoses by mistake while programming doses or pump refills). These can lead to discontinuation of therapy, surgical removal of the pump, or, in rare cases, death.…”

Section: Introductionmentioning

confidence: 99%

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Intrathecal Baclofen Infusion Pumps in the Treatment of Spasticity: A Retrospective Cohort Study in a Portuguese Centre

Reis¹,

Vieira²,

Midões³

et al. 2019

Acta Med Port

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Introduction: Spasticity is a complex problem in patients with neurological disorders and may distress their quality of life. Intrathecal baclofen infusion pumps reduce spasticity with low doses and minimal side effects but are not free from complications. We aimed to evaluate the efficacy and safety of intrathecal baclofen infusion pumps as well as patients' satisfaction. Material and Methods: Retrospective cohort study including all intrathecal baclofen infusion pumps placed up to December 2015. Demographic characteristics, clinical diagnoses, date of placement or withdrawal/replacement of intrathecal baclofen infusion pumps, baclofen dosage and complications of intrathecal baclofen infusion pumps were collected. Assessments from the Ashworth and Penn's scales, Katz index and patients' global satisfaction were analysed. Results: In 19 years we placed 251 intrathecal baclofen infusion pumps in 155 patients. The mean age was 41.1 ± 15.8 years. The most frequent conditions were: trauma (34%), cerebral palsy (14%), multiple sclerosis (12%) and stroke (12%). Eighty-five patients (55%) required a second pump, and eleven (7%) a third one. The lifetime of the first pump was 72 (36 -89) and the total follow-up time was 96 (9 -132) months. The causes of withdrawal/replacement were: battery failure (57%), catheter migration/kinking (24%), infection (14%) and pump displacement/exteriorization (7%). The complication rate was 0.21 events/month. There was a significant improvement in the Ashworth and Penn's scales after the placemen of intrathecal baclofen infusion pumps (p < 0.001 for all diagnoses) and the patients were satisfied with the treatment. Discussion: The incidence of complications was within range of other international studies despite our long follow-up time. Events per month, loss to follow-up, re-intervention rate, incidence of infection and mortality were similar to other studies. Conclusion: Intrathecal baclofen infusion pumps are safe and effective in the treatment of spasticity. Infusion pumps provide a high level of satisfaction regarding treatment and quality of life.Intrathecal baclofen dose (μg/day) -median (P25 -P75) 230 (95 -400)

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Section: Discussionmentioning

confidence: 63%

“…In literature, this rate varies between 0 and 21%. 18,20,21,26 This difference can be explained by the inclusion of different conditions and different follow-up times.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intrathecal Baclofen Infusion Pumps in the Treatment of Spasticity: A Retrospective Cohort Study in a Portuguese Centre

Reis¹,

Vieira²,

Midões³

et al. 2019

Acta Med Port

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“…Intrathecal baclofen for patients with CP safely and effectively reduces spasticity, pain, and dystonia; in addition, it confers superior functional abilities and results in improved management by caregivers. 1,2,[9][10][11][12]21,25,33,36,43,48 However, many patients who require baclofen present with concomitant scoliosis; their spinal torsion, or fusion mass and instrumentation, further increases the challenge of device implantation. 4,6,20,24,27,34,35,41,42 Moreover, procedural complications decrease the cost-benefit ratio of intervention.…”

Section: Discussionmentioning

confidence: 99%

“…6,24,28,39 Although different techniques to circumvent this anatomical complexity have been described, each is associated with notable limitations. Authors have reported drilling through the fusion mass after localization with fluoroscopy, 11 using a K-wire to traverse the mass under fluoroscopic guidance, 43 and inserting catheters at the cervical spine or foramen magnum to avoid entry through the lumbar region altogether. 19,29,47 However, limitations of these approaches include risks of CSF leakage, catheter dislodgement, and adjacent neural injury.…”

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confidence: 99%

Image-guided intrathecal baclofen pump catheter implantation: a technical note and case series

Robinson

Robertson

Dasenbrock

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEMedically refractory spasticity and dystonia are often alleviated with intrathecal baclofen (ITB) administration through an indwelling catheter inserted in the lumbar spine. In patients with cerebral palsy, however, there is a high incidence of concomitant neuromuscular scoliosis. ITB placement may be technically challenging in those who have severe spinal deformity or who have undergone prior instrumented thoracolumbar fusion. Although prior reports have described drilling through the lumbar fusion mass with a high-speed bur, as well as IT catheter implantation at the foramen magnum or cervical spine, these approaches have notable limitations. To the authors' knowledge, this is the first report of ITB placement using cone beam CT (CBCT) image guidance to facilitate percutaneous IT catheterization.METHODSData were prospectively collected on patients treated between November 2012 and June 2014. In the interventional radiology suite, general anesthesia was induced and the patient was positioned prone. Imaging was performed to identify the optimal trajectory. Percutaneous puncture was performed at an entry site with image-guided placement of a sheathed needle. CBCT provided real-time 2D projections and 3D reconstructions for detailed volumetric imaging. A biopsy drill was passed through the sheath, and subsequently a Tuohy needle was advanced intrathecally. The catheter was threaded cephalad under fluoroscopic visualization. After tip localization and CSF flow were confirmed, the stylet was replaced, the external catheter tubing was wrapped sterilely in a dressing, and the patient was transported to the operating room. After lateral decubitus positioning of the patient, the IT catheter was exposed and connected to the distal abdominal tubing with typical pump placement.RESULTSOf 15 patients with Gross Motor Function Classification System Levels IV and V cerebral palsy and instrumented thoracolumbar fusion, 8 had predominantly spasticity, and 7 had mixed spasticity and dystonia. The mean age of patients was 20.1 years (range 13–27 years). Nine patients underwent initial catheter and pump placement, and 6 underwent catheter replacement. The procedure was technically successful, with accurate spinal catheter placement in all patients. The median hospital stay was 4 days (IQR 3–5 days). One patient had an early postoperative urinary tract infection. With a mean follow-up of 25.8 months (median 26, range 18–38 months), no CSF leakage or catheter failure occurred. One late infection due to Pseudomonas aeruginosa (requiring pump explantation) occurred at 4 months, probably secondary to recurrent urinary tract infections.CONCLUSIONSImage-guided CBCT navigation resulted in accurate percutaneous placement of the IT catheter for ITB pumps in patients with prior instrumented thoracolumbar fusion. The multimodality approach is an alternate technique that may be used for IT catheter insertion in patients with complex lumbar spine anatomy, extending the potential to provide safe, durable ITB therapy in this population.

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