Posterior cervical approach for intrathecal baclofen pump insertion in children with previous spinal fusions

Abstract

Intrathecal baclofen pumps for the management of severe spasticity are being used more often in children with cerebral palsy. The intrathecal catheter is traditionally introduced dorsally in the lumbar region. In some children with previous thoracolumbar fusions for scoliosis, the fusion mass obviates the introduction of the intrathecal catheter. The authors describe their experience with a posterior cervical approach for intrathecal baclofen pump insertion in three patients with spastic quadriplegic cerebral palsy who had previously undergone thoracolumbar fusions for scoliosis. Insertion was successful in all three patients; no complications of catheter disconnection, catheter dislodgment, or cerebrospinal fluid leakage occurred. Follow-up review ranged from 10 to 28 months postoperatively (mean 17 months). The posterior cervical approach for intrathecal baclofen pump insertion is a safe and effective alternative for patients who have previously undergone thoracolumbar spine fusions and in whom the traditional lumbar approach is not feasible.