Orthopedic surgery in children with intrathecal baclofen pumps

Gooch, Judith L.; McFadden, Molly; Oberg, Wende

doi:10.3233/prm-140261

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…Our overall impression from our study is that the ITB therapy does not interfere with the underlying natural tendency to develop scoliosis for the most severely disabled children. Likewise, we also observed that the number of the orthopedic surgical interventions did not increase because of the ITB therapy, on contrary, both the orthopedics and the families had tendency to reconsider surgical intervention 22,23 . Because it is rational that if the patient is found relaxed compared to the prepump assessments, one may can-cel the preplanned operation for an individual, while he can identify new potential benefit and onsider orthopedic intervention 18 .…”

Section: Discussionmentioning

confidence: 59%

Continuous intrathecal baclofen delivery in severely disabling spasticity

et al. 2018

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Background/Aim. Spasticity is the consequence of several clinical conditions including cerebral palsy, brain injury, spinal cord injury, multiple sclerosis, aneurysm bleeding, and some other neurological disorders. The aim of this study was to determine the efficacy of intrathecal baclofen (ITB) treatment in medically intractable severely disabling spasticity and present the challenges encountered during pump implantation surgery on these patients. Methods. The patients who underwent intrathecal baclofen pump implantation surgery between the years 2012 and 2015 with minimum follow-up of six months were recruited from the clinic archives. Twenty two patients with severe spasticity who had Modified Asworth Spasticity Scale (MASS) score of 3 or 4 were enrolled in our series. Eight of twenty-two patients were at pediatric age and they all were non-ambulant before surgery. Results. All of the patients underwent programmable intrathecal baclofen pump implantation surgery. Catheters were placed via percutaneous technique into to the subarachnoid space in 18 patients while, we had to perform partial hemi-laminectomy in order to place the catheters in 4 patients. All the patients improved significantly and 5 began using upper extremities and 3 adults became ambulant following physical therapy. Mean of the MASS scores improved from 3.59 to 1.32 (p < 0.001). Conclusion. The ITB therapy obviously increased quality of life and functional outcome in patients with disabling spasticity. As a result, physical treatment was more useful for these patients. Although some spinal abnormalities due to spasticity may necessitate partial hemilaminectomy to implant the pump, patients with intractable spasticity should be given the chance of intrathecal baclofen treatment at the earliest period of their lifetime disability. ApstraktUvod/Cilj. Spasticitet je posledica nekoliko kliničkih stanja kao što su cerebralna paraliza, povrede mozga, povrede kičmene moždine, multipla skleroza, ruptura neurizme sa krvarenjem, kao i neki drugi neurološki poremećaji. Cilj ove studije bio je da se utvrdi efikasnost primene intratekalnog baklofena (ITB) u lečenju upornog teškog onesposobljavajućeg spasticiteta, kao i izazovi sa kojima se susrećemo tokom hirurške ugradnje pumpe kod ovih bolesnika. Metode. Iz kliničkih protokola u periodu 2012-2015. godina izdvojili smo bolesnike kojima je ugrađena baklofenska pumpa intratekalno uz minimlno praćenje od šest meseci. Dvadeset dva bolesnika sa teškim spasticitetom koji su imali modifikovani Asworth skor spasticiteta (MASS) između 3 i 4 bili su uključena u studiju. Osam od 22 bolesnika bila su u dečjem uzrastu i svi su bili nepokretni pre hirurškog zahvata. Rezultati. Svi bolesnici bili su podvrgnuti hirurškoj implantaicji programabilne intratekalne baklofenske pumpe. Kateteri su postavljeni perkutano u subarahnoidni prostor kod 18 bolesnika, dok smo parcijalnu hemilaminektomiju primenili za ugradnju katetera kod četiri bolesnika. Kod svih bolesnika javilo se značajno poboljšanje, 5 bolesnika počelo je da korist...

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Section: Discussionmentioning

confidence: 59%

Continuous intrathecal baclofen delivery in severely disabling spasticity

et al. 2018

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“…23 Similarly, a large retrospective study among a cohort of Japanese community residents demonstrated a negative relationship between BMI categories and pneumoniaassociated mortality. 27 Although the outcome of interest (mortality) in these studies differs from our research, the underlying patho- Age, median (IQR) 13 [8,15] 13 [8,14] 13 [8,15] 12 [8,14] 12 [9,14] 11 [8,14] 11 [7,14] Race possible adverse outcomes than their healthy weight counterparts.…”

Section: Discussionmentioning

confidence: 65%

“…We chose orthopedic procedures because a substantial number of children with neurologic disorders require orthopedic surgical care. [14][15][16] Moreover, studying patients undergoing orthopedic surgery would also be a way to better individualize the specific effects of the neurologic and weight comorbidities on the risk of postoperative pneumonia on the contrary of visceral surgery which has additional and possibly confounding postoperative effects on respiratory mechanics. We hypothesized that obesity in children increases the magnitude of the association between neurologic disorders and postoperative pneumonia.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, our objective was to assess the potential additive effect of obesity and neurologic disorders on the risk of postoperative pneumonia in children undergoing inpatient orthopedic procedures. We chose orthopedic procedures because a substantial number of children with neurologic disorders require orthopedic surgical care 14–16 . Moreover, studying patients undergoing orthopedic surgery would also be a way to better individualize the specific effects of the neurologic and weight comorbidities on the risk of postoperative pneumonia on the contrary of visceral surgery which has additional and possibly confounding postoperative effects on respiratory mechanics.…”

Section: Introductionmentioning

confidence: 99%

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Risk assessment of postoperative pneumonia in children with neurologic disorders and obesity

Owusu-Bediako

Mpody

Iobst

et al. 2022

Pediatric Anesthesia

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Introduction Postoperative pneumonia increases the risk of postsurgical mortality, making it a serious healthcare‐associated complication. Children with preoperative neuromuscular impairments have a higher risk of postoperative pneumonia. Obesity is also a risk factor for postoperative pulmonary complications, including pneumonia. Moreover, obesity is increasingly prevalent among children living with a neurological diagnosis. Whether obesity increases the risk of postoperative pneumonia among children with neurologic diseases remains largely unknown. Therefore, we assessed the risk of postoperative pneumonia among children with neurologic diagnoses based on their obesity status. Methods We analyzed a retrospective cohort of children ≤18 years from the National Surgical Quality Improvement Program (2012–2019) database who underwent inpatient orthopedic surgery. We used Cox proportional regression model to estimate the hazard ratio for the association between neurologic disorders and postoperative pneumonia. In addition, we included an interaction term between body mass index and neurologic disorders to evaluate the moderating effect of obesity status and then performed stratified analyses to compare the magnitude of hazard ratios across body mass index subgroups. Results A total of 60 745 children underwent inpatient orthopedic surgery during the study period, of whom 43.6% were healthy weight and 30.8% overweight/obese. The median age was 13 years (Interquartile range: 8–15). The incidence of postoperative pneumonia was higher among healthy weight patients with neurologic disorders than healthy weight patients without any neurologic disorders [Hazard ratio: 3.55 vs. 0.34]. Furthermore, the association between neurologic disorders and postoperative pneumonia was strongest among overweight patients than healthy weight or obese patients [Hazard ratio:11.88 vs. 9.45 vs. 4.40]. This observation was consistent across the various neurologic disorders analyzed. Conclusion Childhood obesity buffered the association between neurologic disorders and postoperative pneumonia, consistent with an ‘obesity paradox’. Further research exploring the underlying mechanisms for the obesity paradox in children with neurologic disorders is warranted.

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“…Therefore, ITBP did not change the osteotomy rates, which is in concordance with our results. Gooch et al 23 show that there is no significant impact of pump placement on overall orthopedic surgery frequency in 310 children with ITBP. Silva et al 24 show in their comparative study of SDR to ITBP, that in the ITBP group, 32% of hips had reconstruction procedures after ITBP.…”

Section: Discussionmentioning

confidence: 99%

Does intrathecal baclofen therapy decrease the progression of hip displacement in young patients with cerebral palsy?

Asma

Ulusaloğlu

Howard

et al. 2023

Develop Med Child Neuro

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Aim To evaluate the effects of intrathecal baclofen pump (ITBP) therapy on hip dysplasia in young patients with cerebral palsy (CP). Method This was a retrospective cohort series of prospectively collected data. Inclusion criteria were all patients with CP in Gross Motor Function Classification System (GMFCS) levels IV or V who underwent ITBP placement under 8 years old with at least 5 years of follow‐up. Thirty‐four patients were matched to a control group of 71 patients based on GMFCS level, motor type, medical comorbidities, worst hip migration percentage at ITBP placement, age, and Modified Ashworth scale scores. Patients were followed for at least 5 years or until they had hip reconstructive surgery. The primary outcome was the development of hip displacement as measured by the migration percentage at the latest follow‐up or the preoperative migration percentage before hip reconstruction. Results The migration percentage at last follow‐up was not statistically different between groups (ITBP: 36.2%, non‐ITBP: 44.4%, p = 0.14). The rates of future preventative, reconstructive, and recurrent hip surgery were not different between groups. Interpretation The use of ITBP as an early treatment of spasticity did not alter the natural history of progressive hip displacement in non‐ambulatory patients with CP and hip displacement is likely multifactorial, not solely due to spasticity.

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Orthopedic surgery in children with intrathecal baclofen pumps

Cited by 5 publications

References 17 publications

Continuous intrathecal baclofen delivery in severely disabling spasticity

Continuous intrathecal baclofen delivery in severely disabling spasticity

Risk assessment of postoperative pneumonia in children with neurologic disorders and obesity

Does intrathecal baclofen therapy decrease the progression of hip displacement in young patients with cerebral palsy?

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