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Placement of baclofen pumps through the foramen magnum and upper cervical spine.
Childs Nerv Syst. 2006 Mar; 22(3):270-3.CN

Abstract

INTRODUCTION

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+Show Affiliations

Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

15952029

Citation

Dziurzynski, Kristine, et al. "Placement of Baclofen Pumps Through the Foramen Magnum and Upper Cervical Spine." Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, vol. 22, no. 3, 2006, pp. 270-3.
Dziurzynski K, Mcleish D, Ward M, et al. Placement of baclofen pumps through the foramen magnum and upper cervical spine. Childs Nerv Syst. 2006;22(3):270-3.
Dziurzynski, K., Mcleish, D., Ward, M., & Iskandar, B. J. (2006). Placement of baclofen pumps through the foramen magnum and upper cervical spine. Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, 22(3), 270-3.
Dziurzynski K, et al. Placement of Baclofen Pumps Through the Foramen Magnum and Upper Cervical Spine. Childs Nerv Syst. 2006;22(3):270-3. PubMed PMID: 15952029.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Placement of baclofen pumps through the foramen magnum and upper cervical spine. AU - Dziurzynski,Kristine, AU - Mcleish,Deborah, AU - Ward,Michael, AU - Iskandar,Bermans J, Y1 - 2005/06/11/ PY - 2004/10/05/received PY - 2005/6/14/pubmed PY - 2008/10/22/medline PY - 2005/6/14/entrez SP - 270 EP - 3 JF - Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery JO - Childs Nerv Syst VL - 22 IS - 3 N2 - INTRODUCTION: 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. SN - 0256-7040 UR - https://www.unboundmedicine.com/medline/citation/15952029/Placement_of_baclofen_pumps_through_the_foramen_magnum_and_upper_cervical_spine_ L2 - https://dx.doi.org/10.1007/s00381-004-1129-6 DB - PRIME DP - Unbound Medicine ER -