title: Outcomes of posterior spinal fusion and instrumentation in patients with continuous intrathecal baclofen infusion pumps.
abstract: METHODS
  In this retrospective study, 20 spastic quadriplegic cerebral palsy (CP) patients with baclofen pumps, who underwent spinal fusion and instrumentation for neuromuscular scoliosis, were matched for weight, age, and type of fusion with patients without pumps.
  
  
  OBJECTIVE
  The objective of this study is to determine the rate of complications, adverse outcomes, and curve correction after spinal fusion in patients with CP and baclofen pumps compared with similar patients without pumps.
  
  
  BACKGROUND
  CP patients treated with continuous intrathecal baclofen (ITB) can develop neuromuscular scoliosis and may require spinal fusion with instrumentation. ITB pumps may increase complications with this procedure.
  
  
  METHODS
  Medical records were examined, and preoperative risks, intraoperative complications, postoperative complications, and pump-specific complications were documented. Cobb angles were measured throughout the treatment to determine surgical correction.
  
  
  RESULTS
  Pump patients more frequently required reoperation (9 vs. 4, P = 0.039) and rehospitalization (8 vs. 2, P = 0.008). There was a trend toward more wound infections in pump patients (5 vs. 0, P = 0.063). Nine pump patients (45%) had a pump-related complication; 5 of these patients required pump removal or revision. Complications included durotomy, tubing problems, and deep spinal infection. Average surgical correction in pump patients was 42% (81 degrees -48 degrees ) versus 50% (81 degrees -39 degrees ) in nonpump patients, with no significant difference between pairs (P = 0.11).
  
  
  CONCLUSIONS
  CP patients with baclofen pumps who underwent spinal fusion had more complications compared with similar patients without pumps. There was no significant difference in surgical correction between matched pairs. Physicians and families should be aware of the increased risks of reoperation and rehospitalization after spinal fusion in the presence of baclofen pumps.
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA. sugiyama@med.umich.edu
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Caird
authors.forename: Ariel A
authors.initials: AA
authors.lastname: Palanca
authors.forename: Hugh
authors.initials: H
authors.lastname: Garton
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hensinger
authors.forename: Rita N
authors.initials: RN
authors.lastname: Ayyangar
authors.forename: Amy
authors.initials: A
authors.lastname: Drongowski
authors.forename: Frances A
authors.initials: FA
authors.lastname: Farley
mesh_terms: D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects; D002547:Cerebral Palsy / Q000150:complications* / Q000188:drug therapy; D002648:Child; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen