Intrathecal baclofen therapy: complication avoidance and management.
OBJECTIVE
Intrathecal baclofen (ITB) therapy is an accepted treatment modality for spasticity and dystonia. Several complications related to ITB have been described, including mechanical malfunctions, infections, cerebrospinal fluid fistula, and baclofen withdrawal or overdose. In this study, we present our institutional experience with ITB therapy, emphasizing complication avoidance and lessons learned.


METHODS
The charts of 87 patients treated with ITB therapy were retrospectively reviewed. The primary surgical technique, complication type and timing, method of treatment, and outcome were analyzed.


RESULTS
Thirteen out of 76 (17.1%) patients primarily treated at our department had 25 complications. The first complication occurred 17.5-30.9 months (mean 24.2±6.7) after the pump implantation. Additional four patients with pumps placed elsewhere had six complications and were subsequently treated by our group. The main complications were: catheter fracture (11), subcutaneous fluid collection (5), lumbar wound/CSF infection (3), lumbar catheter or connector protrusion (3), pump malfunction (3), distal catheter migration outside the thecal sac (2), and baclofen withdrawal (1). Of the patients in the NYULMC group, six were treated by a single surgical procedure, six underwent multiple surgical procedures, and one was managed conservatively. In retrospect, changing the surgical technique, or adding an abdominal binder may have prevented 17 complications (54.8%). There were two deaths that were unrelated to the ITB therapy.


CONCLUSIONS
ITB therapy is associated with complications, many of which require additional surgery. Some of these complications are avoidable by adhering to a strict surgical technique and a proper criterion for patient selection.
Haranhalli
Neil
N
Department of Neurosurgery, Division of Pediatric Neurosurgery, NYU Langone Medical Center, New York, NY, USA.
Anand
Dhanya
D
Wisoff
Jeffrey H
JH
Harter
David H
DH
Weiner
Howard L
HL
Blate
Michelle
M
Roth
Jonathan
J
D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000009:adverse effects*; D001930:Brain Injuries / Q000188:drug therapy; D002547:Cerebral Palsy / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000295:instrumentation / Q000379:methods; D008297:Male; D009125:Muscle Relaxants, Central / Q000009:adverse effects*; D009128:Muscle Spasticity / Q000188:drug therapy; D012189:Retrospective Studies; D015518:Rett Syndrome / Q000188:drug therapy; D016896:Treatment Outcome
D009125:Muscle Relaxants, Central; D001418:Baclofen