title: Intrathecal baclofen pumps do not accelerate progression of scoliosis in quadriplegic spastic cerebral palsy.
abstract: To compare scoliosis progression in quadriplegic spastic cerebral palsy with and without intrathecal baclofen (ITB) pumps.
  
  
  
  A retrospective matched cohort study was conducted. Patients with quadriplegic spastic cerebral palsy, GMFCS level 5, treated with ITB pumps with follow-up >1 year were matched to comparable cases by age and baseline Cobb angle without ITB pumps. Annual and peak coronal curve progression, pelvic obliquity progression and need for spinal fusion were compared.
  
  
  
  ITB group: 25 patients (9 female), mean age at pump insertion 9.4 and Risser 0.9. Initial Cobb angle 25.6° and pelvic tilt 3.2°. Follow-up 4.3 (1.0-7.8) years. Cobb angle at follow-up 76.1° and pelvic tilt 18.9°. Non-ITB group: 25 patients (14 female), mean age at baseline 9.2 and Risser 1.0. Initial Cobb angle 29.7° and pelvic tilt 7.1°. Follow-up 3.5 (1.0-7.5) years. Cobb angle at follow-up 69.1° and pelvic tilt 21.0°. The two groups were statistically similar for baseline age, Cobb angle and Risser grade. Mean curve progression was 13.6°/year for the ITB group vs 12.6°/year for the non-ITB group (p = 0.39). Peak curve progression was similar between the groups. Pelvic tilt progression was comparable; ITB group 4.5°/year vs non-ITB 4.6°/year (p = 0.97). During follow-up 5 patients in the ITB group and 9 in the non-ITB group required spinal fusion surgery for curve progression (p = 0.35).
  
  
  
  Patients with quadriplegic spastic cerebral palsy with and without ITB pumps showed significant curve progression over time. ITB pumps do not appear to alter the natural history of curve progression in this population.
authors.affiliation: Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK. paulrushton@doctors.org.uk.
authors.forename: Paul R P
authors.identifier: 0000-0002-3387-9416
authors.initials: PRP
authors.lastname: Rushton
authors.affiliation: Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
authors.forename: Luigi A
authors.initials: LA
authors.lastname: Nasto
authors.affiliation: Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
authors.forename: Ranjit K
authors.initials: RK
authors.lastname: Aujla
authors.affiliation: Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
authors.forename: Amr
authors.initials: A
authors.lastname: Ammar
authors.affiliation: Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Grevitt
authors.affiliation: Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Vloeberghs
mesh_terms: D001418:Baclofen / Q000008:administration & dosage*; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy*; D002648:Child; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D011782:Quadriplegia / Q000150:complications; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications* / Q000601:surgery
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: Cerebral palsy; Intrathecal baclofen; Scoliosis; Spastic quadriplegia