Influence of gait analysis on decision-marketing for lower extremity surgery

Baclofen pump implantation and spinal fusions in children:does order or timing influence complications?

A BOROWSKI A,B, AG LITTLETON A, KW DABNEY A, F MILLER A

  1. 1. Department of Orthopedics, Alfred I DuPont Hospital for Children, Nemours Children’s Clinic, Wilmington, DE, USA;
  2. 2.Orthopedics and Pediatric Orthopedics Department, Medical University of Lodz, Lodz, Poland

Background: Intrathecal baclofen therapy (ITB) is a common treatment for spasticity in children with cerebral palsy (CP). This same population also has a high inciodence of spinal deformities requiring posterior spinal fusion (PSF).

Objectives: The goal of this research is to report the technical considerations and complications associated with ITB in patient with PSF.

Design: Retrospective cohort study.

Participants: We reviewed our entire consecutive serried of pediatric patients treated with ITB between 1997 and 2006 at our hospital and identified those patients who also had a spine fusion. Patients were grouped based on the timing of the procedures.

Method: There were four groups of patients: (group 1) 26 with PSF prior to ITB; (group 2) 11 with PSF and ITB concurrently; (group 3) 25 with PSF after ITB; and (group 4) control group, 103 with ITB only. Complications and infections were tabulated from retrospective chart review. Analysis of variance (ANOVA) was used to compare the rate of complications and infections between groups. Specific technical considerations for Group 1 requires a subperiosteal exposure of the fusion mass and the use of a burr to open a hole in the fusion mass. The catheter is passed and secured. The bone hole closed with `Cranoplast’ or `To-Seal’. For Group 2, the intrathecal catheter is implanted before wound closure. The catheter is brought out through the paraspinal muscles, anchored to the fascia, then the catheter is pulled  into lateral pocket, rolled up, and the wound is closed. The patient is then turned suspine and the pump implanted. Group 3 patients have the catheter exposed , cut, removed , and the end tucked into a lateral subcutaneous pocket. After PSF the catheter is reinserted.

Results: ANOVA showed no difference in the rate of infection or device complications between any of the groups.

Group 1: four ncatheter malfunctions, one pump failure, two infections at pump.
Group 2: two catheter malfunctions, one pump hypermobility, one infection at spine.
Group 3: three catheter malfunctions, one infection at pump, one infection at spine.
Control group: 23 catheter malfunctions, five pump failures, eight infections at pump, one infection at spine (Table H:5).

Table H:5 Surgical data

Group
Age (PSF) Mean (SD), y:m
Age (ITB) Mean (SD), y:m
F/u-PSF Mean (SD)
F/u-ITB Mean (SD)
Infections (%)
Device complications (%)
1(n=26)
12:7 (4:1)
16:2 (3:1)
4.2 (2.5)
1.5 (1.0)
7.6
19
2(n=11)
11:9 (4:0)
11:9 (4.0)
3.0 (2.4)
3.0 (2.4)
9
27.2
3(n=25)
15:1 (3:4)
10:11 (4.5)
1.7 (1.2)
4.5(2.3)
8
16
4Control (n=103)
n.a.
11:5 (4:10)
n.a.
3.3 (2.5)
8.7
26

PSF, posterior spinal fusion; ITB, intrathecal baclofen therapy; F/u, follow-up; n.a., not applicable.

Conclusions: ITB therapy complications are not increased in combination with PSF regardless of the order of the procedures. There are technical details in each situation that require attention.

 

 
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