Complication rates for preexisting baclofen pumps and ventricular shunts following scoliosis correction: a preliminary study

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Many patients undergoing spinal fusion for neuromuscular scoliosis have preexisting neurosurgical implants, including ventricular shunts (VSs) for hydrocephalus and baclofen pumps (BPs) for spastic cerebral palsy. Recent studies have discussed a possible increase in implant complication rates following spinal fusion, but published data are inconclusive. The authors therefore, sought to investigate: 1) the rate of implant complications following fusion, 2) possible causes of these complications, and 3) factors that place patients at higher risk for implant-related complications.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Cases involving pediatric patients with a preexisting VS or BP who underwent spinal fusion for scoliosis correction between 2005 and 2016 at a single tertiary children’s hospital were retrospectively analyzed. Patient demographics, implant characteristics, spinal fusion details, neurosurgical follow-up, and implant complications in the 180 days following fusion were recorded and analyzed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Overall, 75 patients who underwent scoliosis correction had preexisting implants: 39 had BPs, 31 VSs, and 5 both. The patients’ mean age at fusion was 13.49 ± 2.78 years (range 3.62–18.81 years), and the mean time from the most recent previous implant surgery to fusion was 5.70 ± 4.65 years (range 0.10–17.3 years). The mean preoperative and postoperative Cobb angles were 62.4° ± 18.9° degrees (range 20.9°–109.0°) and 23.5° ± 13.3° degrees (range 2.00°–67.3°), respectively. No VS complications were identified. Two patients with BPs were found to have complications (unintentional cutting of their BP catheter during posterior spinal fusion) within 180 days postfusion. There were no recorded neurosurgical implant infections, failures, fractures, or dislodgements. Although 10 patients required at least 1 surgical procedure for irrigation and debridement of the spine wound following fusion, there were no abdominal or cranial implant wound infections requiring revision, and no implants required removal.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The results of this study suggest that spinal fusion for scoliosis correction does not increase the rates of complications involving previously placed neurosurgical implants. A large-scale, prospective, multicenter study is needed to fully explore and confirm this finding.</jats:p></jats:sec>

Baclofen Pump Use: Complications After Growth-friendly Instrumentation for Early-onset Scoliosis

“…To our knowledge, few studies [27][28][29][30][31][32][33] have reported complications in patients undergoing baclofen pump implantation and spine surgery, and no studies have focused on GF procedures. We found no significant difference in rates of unplanned surgical intervention between the pump and control groups, consistent with the findings of Dallas et al 29 for spinal fusion. We also demonstrated that postoperative complications remain an important consideration when the pump is inserted before, during, or after the initial GF spine surgery.…”

“…Further, we found no significant difference in the odds of mechanical complications during the follow-up period for patients with versus without pumps. Although previous studies have addressed baclofen pump device complications for patients undergoing both spinal deformity correction and pump insertion, [27][28][29]31 to our knowledge, ours is the first study to address postoperative mechanical complications related to spinal instrumentation in this population. It should be noted that age at surgery and specific diagnosis are not associated with mechanical complications after surgical correction in patients with neuromuscular scoliosis, thereby supporting the lack of difference between our 2 study groups.…”

“…To our knowledge, few studies27–33 have reported complications in patients undergoing baclofen pump implantation and spine surgery, and no studies have focused on GF procedures. We found no significant difference in rates of unplanned surgical intervention between the pump and control groups, consistent with the findings of Dallas et al29 for spinal fusion.…”

Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era

“…A recent study suggested that spinal fusion for neuromuscular scoliosis correction does not increase the rates of complications involving previously placed neurosurgical implants. 58…”

“…Many patients undergoing spinal fusion for neuromuscular scoliosis have preexisting neurosurgical implants, including ventricular shunts for hydrocephalus or baclofen pumps for spasticity control. A recent study suggested that spinal fusion for neuromuscular scoliosis correction does not increase the rates of complications involving previously placed neurosurgical implants [ 59 ].…”