Intrathecal Baclofen Pump Implantation Before, During, or After Posterior Spinal Fusion in Children with Cerebral Palsy

Complications are associated with intrathecal baclofen pump (ITB) implantation in children with cerebral palsy (CP) who have had a posterior spinal fusion (PSF), concurrently had a PSF, or had a PSF after a previous ITB implantation. Twenty-four children with spastic quadriplegic CP had a PSF with unit rod instrumentation for treatment of neuromuscular scoliosis before, during, or after implantation of an ITB pump. All of the patients had a significant reduction in spasticity following ITB. Postoperative curve correction was 78%. There were 4 complications: two patients had a dural leak, one patient developed an infection necessitating pump removal, and one patient developed acute baclofen withdrawal due to occlusion of the catheter by a sublaminar wire. In children with CP and neuromuscular scoliosis, ITB pumps can be safely implanted before, during, or after PSF and instrumentation, provided certain techniques are followed to avoid complications of catheter entrapment, dural leaks, and infection. Our technique has evolved with experience, and is outlined here for the three various scenarios.