The use of intrathecal baclofen pump implants in children and adolescents: safety and complications in 200 consecutive cases

Object. The authors investigated the efficacy of intrathecal baclofen therapy, analyzing the complications and risk factors in 200 consecutive patients who received pump implants. Methods. The patient population included 200 patients (mean age 13.7 +/- 5.68 years). The follow-up duration varied from 13.07 to 87.50 months (mean 50.71 months). Results. The mean Ashworth Scale, Barry-Albright Dystonia Scale, clonus, and spasm scores decreased postoperatively. Overall, 31% of patients experienced complications as follows: 11% had cerebrospinal fluid leakage, 7% had catheter-related problems, 7.5% suffered infections; 5.5% of patients had more than one complication. Conclusions. The authors found that the onset of at least one complication is statistically more likely in patients with Ashworth Scale scores higher than 3 and an age of 10 years or younger. A reduction in the incidence of infection from 10 to 4.8% by the end of the study period appears to be correlated with the switch in technique to subfascial instead of subcutaneous pump implantation and the adoption of a new preoperative prophylaxis protocol in the last 51 patients. There were no statistically significant correlations between the onset of complications and patient weight, ambulatory status, or the presence of dystonia or cerebral palsy.