Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients

Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients

Vender JR; Hester S; Waller JL; Rekito A; Lee MR

Journal of Neurosurgery

2006

PedPal Lit; Adult Age Factors Baclofen/administration & dosage/adverse effects/therapeutic use Child Comparative Study Dystonia/drug therapy GABA Agonists/administration & dosage/adverse effects/therapeutic use Humans Infusion Pumps; Implantable/adverse effects Muscle Spasticity/drug therapy Reoperation Retrospective Studies Risk Factors Surgical Wound Infection Treatment Outcome

OBJECT: Intrathecal baclofen therapy is an effective means of treating intractable spasticity and dystonia in the pediatric and adult population. The authors present a review of complications encountered in a series of 314 pump and catheter-related procedures. The identification and management of these complications will be reviewed. The authors will also identify populations that may be at increased risk for complications. METHODS: A retrospective review was performed of all procedures undertaken during the last 5 years by two surgeons at the authors' institution. Postoperative complications were reviewed. A total of 314 surgical procedures (226 pediatric and 88 adult) were performed in 195 pediatric and adult patients. This included 171 new pump and catheter implants (116 pediatric and 55 adult), 26 elective pump replacements due to end of battery life (15 pediatric and 11 adult), five elective pump repositionings per physiatrist request (three pediatric and two adult), 14 elective catheter repositionings (10 pediatric and four adult), and two normal pediatric catheter explorations. Surgical procedures for complication management included seven pump revisions (five pediatric and two adult), 48 catheter revisions (38 pediatric and 10 adult), and 41 wound revisions (37 pediatric and four adult). The majority of adult pumps were implanted subdermally, whereas in pediatric patients they were placed subfascially. In general, intrathecal catheters were placed under fluoroscopic guidance with the catheter tip placed at T-1 to T-2 for spastic quadriplegia, T-6 to T-10 for spastic diplegia, and midcervical for dystonia. No significant intraoperative complications were encountered. Overall, there was a statistically significantly higher percentage of procedures for overall complication management and wound complication management in pediatric patients compared with adult patients. CONCLUSIONS: Intrathecal baclofen therapy is a highly effective treatment option for patients with medically refractory spasticity. The catheter, pump, and wound are subject to numerous complications both at the time of implantation and throughout the life of the implanted system. Careful technique, close observation, and aggressive evaluation and correction of problems can reduce the incidence and severity of the complications when they occur.

2006

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