Complications of intrathecal baclofen pump therapy in pediatric patients.
BACKGROUND
The aim of this study was to investigate and evaluate complications of intrathecal baclofen (ITB) pump implantation and maintenance in children with cerebral palsy.


METHODS
We reviewed our entire consecutive series of pediatric patients treated with ITB between 1997 and 2006 at our hospital. There were 174 patients with a diagnosis of cerebral palsy, 8 with mixed dystonia, 2 with athetosis, and 3 with pure dystonia. During follow-up, 8 deaths occurred with no evidence of pump or catheter malfunction in any way contributing to the cause of death. Acute infection within 60 days of the surgery and late infection rates were calculated on the basis of number of incidents and incidents/follow-up patient years, respectively. Independently, a blinded caregiver phone questionnaire was completed in 92 cases.


RESULTS
There were 316 surgical procedures; 161 were initial ITB pump implants at our institution. The average age at initial implant was 12 years, with an average follow-up of 3 years, 2 months. There were 80 planned replacement procedures (46 battery expirations and 3 planned pump replacements during posterior spinal fusion, 26 catheter replacements for posterior spinal fusion, and 5 reinsertions). There were 78 procedures in 57 patients related to complications, and the acute infection rate was 4.0%. The probability of developing a late infection was 1.0% per year of follow-up. On the basis of the follow-up questionnaire, 81% of parents/caregivers were satisfied with the treatment, and 87% would recommend ITB therapy.


CONCLUSIONS
ITB therapy is a safe and effective treatment for severe spasticity in the pediatric population, but does have a 31% rate of complications requiring surgical management over a 3-year treatment period. Parents and caregivers have a high rate of satisfaction and most would recommend the treatment to others.
Borowski
Andrzej
A
Department of Orthopedics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE 19899, USA.
Littleton
Aaron G
AG
Borkhuu
Battugs
B
Presedo
Ana
A
Shah
Suken
S
Dabney
Kirk W
KW
Lyons
Sharon
S
McMannus
Maura
M
Miller
Freeman
F
D000293:Adolescent; D001418:Baclofen / Q000008:administration & dosage / Q000009:adverse effects*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000209:etiology; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000009:adverse effects*; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors
D009125:Muscle Relaxants, Central; D001418:Baclofen