Aims: Children with cerebral palsy often have severe spasticity leading to deformity that requires multiple orthopedic surgeries. Intrathecal baclofen pump implantation effectively decreases severe spasticity. The objective of this study was to determine whether children who have a baclofen pump implanted at a young age have fewer orthopedic surgeries than those who have a baclofen pump implanted at later ages.
Methods: In this retrospective study of 310 children, we compared occurrence of surgery in relation to having or not having the baclofen pump, by using survival analysis with surgery as the outcome, presence of baclofen pump as the exposure of interest, modeled as a time-dependent variable, and age as the time scale.
Results: There was no significant effect of pump placement on overall surgery frequency. Analyses by type of surgery showed that those without a pump in place had a 64% lower hazard of scoliosis surgery.
Conclusions: No evidence was found to indicate that children who have a baclofen pump implanted at a young age have fewer orthopedic surgeries than those who have a baclofen pump implanted at later ages.
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http://dx.doi.org/10.3233/PRM-140261 | DOI Listing |
Int Orthop
December 2024
Baylor College of Medicine, Department of Orthopedics, Houston, TX, USA.
Purpose: While surgical intervention of scoliosis in cerebral palsy (CP) patients has shown notable improvements in quality of life, the high risk of post-operative complications in CP patients necessitates careful preoperative optimization. A preoperative multidisciplinary (Multi-D) pathway at our tertiary pediatric hospital in effect since 2014 led to a significant reduction in mortality at one year. However, such a strategy delays surgery, potentially increasing the risk of curve progression.
View Article and Find Full Text PDFJ Neurosurg Case Lessons
December 2024
Physical Medicine and Rehabilitation, Weill-Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York.
Background: While the symptoms of Huntington's disease (HD) typically first appear around the age of 40 years, 5%-10% of patients experience symptoms before the age of 21 years, in which case it is classified as juvenile Huntington's disease (JHD). JHD poses a unique clinical problem, as affected patients experience rapid deterioration in their quality of life as the motor manifestations of the disease become overwhelming. Medical treatment options for HD are sparse, and the only Food and Drug Administration-approved medication for the treatment of HD is the VMAT-2 inhibitor tetrabenazine.
View Article and Find Full Text PDFJ Neurosurg Case Lessons
December 2024
Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
Background: Intrathecal baclofen pump (ITBP) therapy has been successfully used to treat hypertonia in children with cerebral palsy (CP) since its Food and Drug Administration approval in 1984. CP affects multiple organ systems, leading to the accumulation of medical access and implantable devices, increasing the medical complexity of these children. The authors present the case of a patient with extreme surgical complexity and review the medical decision-making and surgical details.
View Article and Find Full Text PDFJ Pain Palliat Care Pharmacother
November 2024
Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA.
We present the case of a 45-year-old male with a history of multiple sclerosis complicated by spasticity and paraplegia, who developed altered mental status and type II respiratory failure requiring intubation on the same day his intrathecal baclofen pump was refilled by his pain physician. Shortly after admission, the patient experienced cardiac arrest four times within two hours until the pump contents were aspirated, and the patient was stabilized. This case report emphasizes the significance of vigilance and prompt recognition of intrathecal baclofen poisoning, which can lead to life-threatening toxicities and withdrawals.
View Article and Find Full Text PDFOper Neurosurg (Hagerstown)
November 2024
Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA.
Background And Importance: Intrathecal baclofen (ITB) pumps are used for the treatment of pediatric movement disorders that are rapidly progressive or do not respond to medical management. An ITB test dose is indicated in patients who have mixed tone, when the family remains unconvinced, or when insurance companies require it. Test doses are typically delivered by lumbar puncture; however, lumbar puncture in patients with heterotopic ossification of the lumbar vertebrae after a previous spinal fusion is not possible.
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