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Does Intrathecal Baclofen Therapy Increase Prevalence and/or Progression of Neuromuscular Scoliosis?
Spine Deform. 2017 11; 5(6):424-429.SD

Abstract

STUDY DESIGN

Retrospective, case-matched review.

OBJECTIVES

Compare a group of individuals with cerebral palsy (CP) who had intrathecal baclofen (ITB) pumps to a group of individuals with CP who did not have ITB pumps in order to determine if there was a difference in the prevalence of new-onset neuromuscular scoliosis, an increased rate of progression of preexisting neuromuscular scoliosis, or an increased rate of posterior spine fusion surgery in skeletally immature individuals with CP who had ITB pumps.

SUMMARY OF BACKGROUND DATA

Various authors report conflicting findings, with some reporting an increased incidence or prevalence of scoliosis in individuals with CP who have ITB pumps whereas others report no difference in the rate of scoliosis between groups.

METHODS

Retrospective chart and radiographic case-matched study in which individuals were matched by gender and Gross Motor Function Classification Scale (GMFCS) level.

RESULTS

We found no difference in the rates of new-onset neuromuscular scoliosis for those with CP and ITB pumps and those without ITB pumps. However, we did see a higher rate of progression as well as an increased rate of posterior spine fusion surgery in individuals with CP who had ITB pumps than for those with CP who did not have an ITB pump.

CONCLUSIONS

We continue to recommend ITB pump therapy for individuals with severe spasticity associated with CP (GMFCS IV and V). There is a significant risk of complications for individuals in general. The risk of neuromuscular scoliosis is relatively high in this population. Our findings suggest that individuals with CP who have ITB pumps and who do or do not have preexisting scoliosis should be monitored closely for either developing new neuromuscular scoliosis or progression of preexisting scoliosis.

Authors+Show Affiliations

Gillette Children's Specialty Healthcare, 200 University Ave East, St. Paul, MN 55101, USA; Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55454, USA. Electronic address: walke009@umn.edu.Gillette Children's Specialty Healthcare, 200 University Ave East, St. Paul, MN 55101, USA.Courage Kenny Rehabilitation Institute, 800 E. 28th Street, Minneapolis, MN 55407, USA; Department of Physical Medicine and Rehabilitation, University of Minnesota, 410 Church St. SE, Minneapolis, MN 55455, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29050720

Citation

Walker, Kevin R., et al. "Does Intrathecal Baclofen Therapy Increase Prevalence And/or Progression of Neuromuscular Scoliosis?" Spine Deformity, vol. 5, no. 6, 2017, pp. 424-429.
Walker KR, Novotny SA, Krach LE. Does Intrathecal Baclofen Therapy Increase Prevalence and/or Progression of Neuromuscular Scoliosis? Spine Deform. 2017;5(6):424-429.
Walker, K. R., Novotny, S. A., & Krach, L. E. (2017). Does Intrathecal Baclofen Therapy Increase Prevalence and/or Progression of Neuromuscular Scoliosis? Spine Deformity, 5(6), 424-429. https://doi.org/10.1016/j.jspd.2017.03.006
Walker KR, Novotny SA, Krach LE. Does Intrathecal Baclofen Therapy Increase Prevalence And/or Progression of Neuromuscular Scoliosis. Spine Deform. 2017;5(6):424-429. PubMed PMID: 29050720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does Intrathecal Baclofen Therapy Increase Prevalence and/or Progression of Neuromuscular Scoliosis? AU - Walker,Kevin R, AU - Novotny,Susan A, AU - Krach,Linda E, PY - 2016/12/16/received PY - 2017/03/16/revised PY - 2017/03/19/accepted PY - 2017/10/21/entrez PY - 2017/10/21/pubmed PY - 2019/1/16/medline KW - Cerebral palsy KW - Intrathecal baclofen pump KW - Neuromuscular scoliosis KW - Posterior spine fusion SP - 424 EP - 429 JF - Spine deformity JO - Spine Deform VL - 5 IS - 6 N2 - STUDY DESIGN: Retrospective, case-matched review. OBJECTIVES: Compare a group of individuals with cerebral palsy (CP) who had intrathecal baclofen (ITB) pumps to a group of individuals with CP who did not have ITB pumps in order to determine if there was a difference in the prevalence of new-onset neuromuscular scoliosis, an increased rate of progression of preexisting neuromuscular scoliosis, or an increased rate of posterior spine fusion surgery in skeletally immature individuals with CP who had ITB pumps. SUMMARY OF BACKGROUND DATA: Various authors report conflicting findings, with some reporting an increased incidence or prevalence of scoliosis in individuals with CP who have ITB pumps whereas others report no difference in the rate of scoliosis between groups. METHODS: Retrospective chart and radiographic case-matched study in which individuals were matched by gender and Gross Motor Function Classification Scale (GMFCS) level. RESULTS: We found no difference in the rates of new-onset neuromuscular scoliosis for those with CP and ITB pumps and those without ITB pumps. However, we did see a higher rate of progression as well as an increased rate of posterior spine fusion surgery in individuals with CP who had ITB pumps than for those with CP who did not have an ITB pump. CONCLUSIONS: We continue to recommend ITB pump therapy for individuals with severe spasticity associated with CP (GMFCS IV and V). There is a significant risk of complications for individuals in general. The risk of neuromuscular scoliosis is relatively high in this population. Our findings suggest that individuals with CP who have ITB pumps and who do or do not have preexisting scoliosis should be monitored closely for either developing new neuromuscular scoliosis or progression of preexisting scoliosis. SN - 2212-1358 UR - https://www.unboundmedicine.com/medline/citation/29050720/Does_Intrathecal_Baclofen_Therapy_Increase_Prevalence_and/or_Progression_of_Neuromuscular_Scoliosis L2 - https://linkinghub.elsevier.com/retrieve/pii/S2212-134X(16)30239-8 DB - PRIME DP - Unbound Medicine ER -