Intrathecal baclofen therapy for spasticity of cerebral origin--does the position of the intrathecal catheter matter?

Abstract

Objective: To assess the correlation between the position of the intrathecal baclofen therapy catheter with the clinical outcome and response to the spasticity.

Methods and results: A prospective cohort study was done by reviewing the paediatric group of patients with spasticity of cerebral origin who had insertion of a programmable baclofen pump for intrathecal administration in the last 10 years (August 1998 to September 2007). A total of 190 procedures were carried out in 166 patients, under a single paediatric neurosurgeon, with an age range of 18 months-16 years (mean 8.75 years) with follow up of 1-10 years (mean 5 years). The routine post-operative X-rays, which were done as per protocol, were reviewed, and the position of the intrathecal catheter tip was documented in relation to the vertebral bodies. The maintenance intrathecal baclofen dose was 25 microgms to 1,000 microgms (mean 255.8 microgms) based on the clinical response to spasticity. Statistical analysis was carried out to assess the correlation of the position of the tip of the intrathecal catheter with the outcome in spasticity based on GMFCS (Gross Motor Function Classification System) and Ashworth score.

Conclusion: In our series, there was no statistically significant correlation between the position of the intrathecal catheter and the clinical response to the spasticity.