title: Placement of baclofen pumps through the foramen magnum and upper cervical spine.
abstract: BACKGROUND
  The baclofen pump has been utilized in children with refractory spasticity. However, in children with prior lumbar fusion, the implantation of such a device is difficult and fraught with complications. As an alternative to placing the pump catheter through the lumbar spine, we report our experience with placement of the catheter in the spinal canal via a cervical approach through the foramen magnum.
  
  
  METHODS
  We have followed three patients with prior lumbar fusion and refractory spasticity, each of whom has undergone placement of the intrathecal component of a baclofen pump via the foramen magnum. Appropriate positioning of the catheter tip at the T6 spinal level was determined using intraoperative fluoroscopy. The catheter was then tunneled to the pump in the abdominal wall.
  
  
  RESULTS
  All patients experienced a significant decrease in the severity of spasticity with pump placement. The pumps continued to function properly over a follow-up period of 24, 24, and 44 months respectively. In one patient, the catheter recoiled into the subcutaneous tissues several months after its placement, thus necessitating repositioning. One of the pumps was removed 2 years later secondary to a VP shunt infection. However, there were no immediate complications related to placement of the spinal catheter.
  
  
  CONCLUSIONS
  Placement of the intraspinal component of a baclofen pump via the foramen magnum is a viable alternative for patients with spastic quadriparesis with prior lumbar fusion. The tip of the spinal catheter can be positioned in the thoracic region in a similar manner to the placement traditional lumbar pumps. In our series, there were no adverse sequelae related to the surgery or catheter positioning.
authors.affiliation: Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Dziurzynski
authors.forename: Deborah
authors.initials: D
authors.lastname: Mcleish
authors.forename: Michael
authors.initials: M
authors.lastname: Ward
authors.forename: Bermans J
authors.initials: BJ
authors.lastname: Iskandar
mesh_terms: D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage*; D002408:Catheters, Indwelling; D002547:Cerebral Palsy / Q000150:complications; D002574:Cervical Vertebrae; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005539:Foramen Magnum / Q000601:surgery; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000188:drug therapy; D011782:Quadriplegia / Q000150:complications / Q000188:drug therapy*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen