Effect of Intrathecal Baclofen Pump on Scoliosis in Children With Cerebral Palsy: A Meta-Analysis

Lee, Soolim; Hyun, Cheolhwan; Kim, Kyungmin; Kwon, Hyo Eun; Woo, Minwoo; Koh, Seong-Eun

doi:10.5535/arm.22108

Cited by 5 publications

(4 citation statements)

References 34 publications

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“…25,26 Lumbosacral VDR has the potential to address the relative contraindications of ITBP including scoliosis, epilepsy, low weight, and an age < 4 years. 10,12 The prevalence of scoliosis and epilepsy in our cohort was 71% and 57%, respectively. We observed no increase in seizure frequency or worsening of spinal deformity associated with the VDR in the follow-up period, but long-term follow-up is mandatory in this patient population.…”

Section: Indicationsmentioning

confidence: 77%

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Nonselective lumbosacral ventral-dorsal rhizotomy for the management of lower-limb hypertonia in nonambulatory children with cerebral palsy

Abdelmageed,

Dalmage,

Mossner

et al. 2024

Neurosurgical Focus

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OBJECTIVE Children with cerebral palsy (CP) often experience medically refractory hypertonia, for which there are surgical therapies including neuromodulation and rhizotomy. Traditional surgical treatment for medically refractory mixed hypertonia or dystonia includes intrathecal baclofen pumps and selective dorsal rhizotomy. A nonselective lumbosacral ventral-dorsal rhizotomy (VDR; ventral and dorsal roots lesioned by 80%–90%) has the potential to address the limitations of traditional surgical options. The authors highlighted the institutional safety and efficacy of nonselective lumbosacral VDR for palliative tone management in nonambulatory patients with more severe CP. METHODS The authors performed a retrospective analysis of patients who had undergone lumbosacral VDR between 2022 and 2023. Demographic factors, clinical variables, and operative characteristics were collected. The primary outcomes of interest included tone control and quality of life improvement. Secondary outcome measures included, as a measure of safety, perioperative events such as paresthesias. Postoperative complications were also noted. RESULTS Fourteen patients (7 female) were included in the study. All patients had undergone a T12–L2 osteoplastic laminoplasty and bilateral L1–S1 VDR. Nine patients had quadriplegic mixed hypertonia, 4 had quadriplegic spasticity, and 1 had generalized secondary dystonia. Following VDR, there was a significant decrease in both lower-extremity modified Ashworth Scale (mAS) scores (mean difference [MD] −2.77 ± 1.0, p < 0.001) and upper-extremity mAS scores (MD −0.71 ± 0.76, p = 0.02), with an average follow-up of 3 months. In the patient with generalized dystonia, the lower-extremity Barry-Albright Dystonia Scale score decreased from 8 to 0, and the overall score decreased from 32 to 13. All parents noted increased ease in caregiving, particularly in terms of positioning, transfers, and changing. The mean daily enteral baclofen dose decreased from 47 mg preoperatively to 24.5 mg postoperatively (p < 0.001). Three patients developed wound dehiscence, 2 of whom had concurrent infections. CONCLUSIONS Lumbosacral VDR is safe, is effective for tone control, and can provide quality of life improvements in patients with medically refractory lower-limb mixed hypertonia. Lumbosacral VDR can be considered for palliative tone control in nonambulatory patients with more severe CP. Larger studies with longer follow-ups are necessary to further determine safety and long-term benefits in these patients.

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Section: Indicationsmentioning

confidence: 77%

“…11 A recent meta-analysis demonstrated that ITBP insertion accelerates the annual Cobb angle progression in children with CP. 12 Some practitioners consider the ITBP to be relatively contraindicated in patients with epilepsy given concerns about increasing seizure frequency. A recent meta-analysis noted a 38% pooled prevalence of epilepsy in CP.…”

mentioning

confidence: 99%

Nonselective lumbosacral ventral-dorsal rhizotomy for the management of lower-limb hypertonia in nonambulatory children with cerebral palsy

Abdelmageed,

Dalmage,

Mossner

et al. 2024

Neurosurgical Focus

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“…ITBP demonstrates reduction in upper extremity mAS scores by 0.8 to 1.8 compared with 1.75 to 2.5 in our cohort [26,27]. Moreover, ITBP is relatively contraindicated in patient populations with low weight, epilepsy, scoliosis, and age less than four and cervical VDR is not similarly constrained [28,29]. This study included patients aged 7-34 and there was no cognitive threshold imposed.…”

Section: Indications and Considerationsmentioning

confidence: 92%

Cervicothoracic Ventral-Dorsal Rhizotomy for Treatment of Brachial Hypertonia in Cerebral Palsy

Abdelmageed,

Dalmage,

Mossner

et al. 2024

Preprint

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Purpose Cervicothoracic ventral-dorsal rhizotomy (VDR) is a potential treatment of medically refractory hypertonia in children who are not candidates for intrathecal baclofen, particularly in cases of severe upper limb hypertonia with limited to no function. A longitudinal cohort was identified to highlight our institutional safety and efficacy using cervicothoracic VDR for the treatment of hypertonia. Methods Retrospective data analysis was performed for children that underwent non-selective cervicothoracic VDR between 2022–2023. Non-modifiable risk factors, clinical variables, and operative characteristics were collected. Results 6 patients (3 female) were included. Four patients underwent a bilateral C6-T1 VDR, one patient underwent a left C7-T1 VDR, and another underwent a left C6-T1 VDR. Three patients had quadriplegic mixed hypertonia, one patient had quadriplegic spasticity, one patient had triplegic mixed hypertonia, and one patient had mixed hemiplegic hypertonia. The mean difference of proximal upper extremity modified Ashworth scale (mAS) was − 1.4 ± 0.55 (p = 0.002), and − 2.2 ± 0.45 (p < 0.001) for the distal upper extremity. Both patients with independence noted quality of life improvements as well as increased ease with dressing and orthotics fits. Caregivers for the remaining four patients noted improvements in caregiving provision, mainly in dressing, orthotics fit, and ease when transferring. Conclusion Cervicothoracic VDR is safe, provides tone control and quality of life improvements in short-term follow-up. It can be considered for the treatment of refractory hypertonia. Larger multicenter studies with longer follow-up are necessary to further determine safety along with long-term functional benefits in these patients.

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“…However, the impact on scoliosis after ITB pump implantation has been controversial in children with CP with further scoliosis progression [18][19][20] vs. no significant difference [21,22]. In their study published in current issue of Annals of Rehabilitation Medicine, Lee et al [23] performed a systematic review and meta-analysis www.e-arm.org which showed that ITB pump implantation accelerates annual Cobb's angle progression in children with CP. Patients with ITB pump implantation showed a faster rate of scoliosis progression probably due to paraspinal muscle hypotonia, although patients with no ITB pump implantation also showed aggravation of scoliosis.…”

mentioning

confidence: 99%

Intrathecal Baclofen Therapy: Pros and Cons

Cho¹

2023

Ann Rehabil Med

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Effect of Intrathecal Baclofen Pump on Scoliosis in Children With Cerebral Palsy: A Meta-Analysis

Cited by 5 publications

References 34 publications

Nonselective lumbosacral ventral-dorsal rhizotomy for the management of lower-limb hypertonia in nonambulatory children with cerebral palsy

Nonselective lumbosacral ventral-dorsal rhizotomy for the management of lower-limb hypertonia in nonambulatory children with cerebral palsy

Cervicothoracic Ventral-Dorsal Rhizotomy for Treatment of Brachial Hypertonia in Cerebral Palsy

Intrathecal Baclofen Therapy: Pros and Cons

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