Outcomes of Posterior Spinal Fusion and Instrumentation in Patients With Continuous Intrathecal Baclofen Infusion Pumps.
Caird, Michelle S. MD *; Palanca, Ariel A. BS +; Garton, Hugh MD ++; Hensinger, Robert N. MD *; Ayyangar, Rita N. MD [S]; Drongowski, Amy MA *; Farley, Frances A. MD *
33(4):E94-E99, February 15, 2008.
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Study Design. In this retrospective study, 20 spastic quadriplegic cerebral palsy (CP) patients with baclofen pumps, who underwent spinal fusion and instrumentation for neuromuscular scoliosis, were matched for weight, age, and type of fusion with patients without pumps.
Objective. The objective of this study is to determine the rate of complications, adverse outcomes, and curve correction after spinal fusion in patients with CP and baclofen pumps compared with similar patients without pumps.
Summary of Background Data. CP patients treated with continuous intrathecal baclofen (ITB) can develop neuromuscular scoliosis and may require spinal fusion with instrumentation. ITB pumps may increase complications with this procedure.
Methods. Medical records were examined, and preoperative risks, intraoperative complications, postoperative complications, and pump-specific complications were documented. Cobb angles were measured throughout the treatment to determine surgical correction.
Results. Pump patients more frequently required reoperation (9 vs. 4, P = 0.039) and rehospitalization (8 vs. 2, P = 0.008). There was a trend toward more wound infections in pump patients (5 vs. 0, P = 0.063). Nine pump patients (45%) had a pump-related complication; 5 of these patients required pump removal or revision. Complications included durotomy, tubing problems, and deep spinal infection. Average surgical correction in pump patients was 42% (81[degrees]-48[degrees]) versus 50% (81[degrees]-39[degrees]) in nonpump patients, with no significant difference between pairs (P = 0.11).
Conclusion. CP patients with baclofen pumps who underwent spinal fusion had more complications compared with similar patients without pumps. There was no significant difference in surgical correction between matched pairs. Physicians and families should be aware of the increased risks of reoperation and rehospitalization after spinal fusion in the presence of baclofen pumps.
(C) 2008 Lippincott Williams & Wilkins, Inc.