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Cervical implantation of intrathecal baclofen pump catheter in children with severe scoliosis.
J Neurosurg Pediatr. 2012 Jul; 10(1):34-8.JN

Abstract

OBJECT

Intrathecal baclofen (ITB) pump catheter placement is traditionally performed through entry into the spinal sac at the lumbar spine. A minority of children with cerebral palsy have severe concomitant neuromuscular scoliosis. In these children, whether surgically treated or not, access to the intradural space via the lumbar spine may prove technically challenging. The authors report on a series of children in whom, for various reasons, an ITB catheter was implanted using a posterior cervical spine approach.

METHODS

The records of 20 children in whom a baclofen catheter had been placed were retrospectively reviewed to assess the demographic details, indications, and outcome of this procedure.

RESULTS

This approach was successful in all but one of the children in whom the procedure was abandoned given the presence of significant extradural scar tissue. Of the 20 children, 7 had previously undergone lumbar ITB catheter implantation, although the catheter was subsequently, iatrogenically transected during scoliosis surgery. Nine children had had corrective scoliosis surgery, and the fusion mass obviated access to the lumbar spinal sac. Four children had untreated scoliosis and corrective surgery was being contemplated. Complications included infection requiring explantation (2 patients), catheter migration (1 patient), intolerance to ITB (1 patient), and failure of implantation (1 patient). All patients who tolerated the ITB experienced improvement in spasticity. No complications were associated with the spinal level of catheter insertion.

CONCLUSIONS

Implantation of an ITB catheter via a cervical approach is safe and feasible and should be considered in children with severe corrected or uncorrected scoliosis, and thus avoiding the lumbar spinal sac.

Authors+Show Affiliations

Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom. sortofish@doctors.net.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22702326

Citation

Ughratdar, Ismail, et al. "Cervical Implantation of Intrathecal Baclofen Pump Catheter in Children With Severe Scoliosis." Journal of Neurosurgery. Pediatrics, vol. 10, no. 1, 2012, pp. 34-8.
Ughratdar I, Muquit S, Ingale H, et al. Cervical implantation of intrathecal baclofen pump catheter in children with severe scoliosis. J Neurosurg Pediatr. 2012;10(1):34-8.
Ughratdar, I., Muquit, S., Ingale, H., Moussa, A., Ammar, A., & Vloeberghs, M. (2012). Cervical implantation of intrathecal baclofen pump catheter in children with severe scoliosis. Journal of Neurosurgery. Pediatrics, 10(1), 34-8. https://doi.org/10.3171/2012.3.PEDS11474
Ughratdar I, et al. Cervical Implantation of Intrathecal Baclofen Pump Catheter in Children With Severe Scoliosis. J Neurosurg Pediatr. 2012;10(1):34-8. PubMed PMID: 22702326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical implantation of intrathecal baclofen pump catheter in children with severe scoliosis. AU - Ughratdar,Ismail, AU - Muquit,Samiul, AU - Ingale,Harshal, AU - Moussa,Ahmad, AU - Ammar,Amr, AU - Vloeberghs,Michael, Y1 - 2012/06/15/ PY - 2012/6/19/entrez PY - 2012/6/19/pubmed PY - 2012/9/11/medline SP - 34 EP - 8 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 10 IS - 1 N2 - OBJECT: Intrathecal baclofen (ITB) pump catheter placement is traditionally performed through entry into the spinal sac at the lumbar spine. A minority of children with cerebral palsy have severe concomitant neuromuscular scoliosis. In these children, whether surgically treated or not, access to the intradural space via the lumbar spine may prove technically challenging. The authors report on a series of children in whom, for various reasons, an ITB catheter was implanted using a posterior cervical spine approach. METHODS: The records of 20 children in whom a baclofen catheter had been placed were retrospectively reviewed to assess the demographic details, indications, and outcome of this procedure. RESULTS: This approach was successful in all but one of the children in whom the procedure was abandoned given the presence of significant extradural scar tissue. Of the 20 children, 7 had previously undergone lumbar ITB catheter implantation, although the catheter was subsequently, iatrogenically transected during scoliosis surgery. Nine children had had corrective scoliosis surgery, and the fusion mass obviated access to the lumbar spinal sac. Four children had untreated scoliosis and corrective surgery was being contemplated. Complications included infection requiring explantation (2 patients), catheter migration (1 patient), intolerance to ITB (1 patient), and failure of implantation (1 patient). All patients who tolerated the ITB experienced improvement in spasticity. No complications were associated with the spinal level of catheter insertion. CONCLUSIONS: Implantation of an ITB catheter via a cervical approach is safe and feasible and should be considered in children with severe corrected or uncorrected scoliosis, and thus avoiding the lumbar spinal sac. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/22702326/Cervical_implantation_of_intrathecal_baclofen_pump_catheter_in_children_with_severe_scoliosis_ L2 - https://thejns.org/doi/10.3171/2012.3.PEDS11474 DB - PRIME DP - Unbound Medicine ER -