The risk of progression of scoliosis in cerebral palsy patients after intrathecal baclofen therapy

Spine (Phila Pa 1976). 2007 Oct 1;32(21):2348-54. doi: 10.1097/BRS.0b013e3181557252.

Abstract

Study design: Retrospective radiographic and medical chart review with matched control group.

Objective: To identify the effect of intrathecal baclofen on the incidence of scoliosis, rate of curve progression, and pelvic obliquity compared with a matched cohort.

Summary of background data: Although intrathecal baclofen therapy (ITB) has been shown to be effective in decreasing spasticity, case reports have described some children receiving ITB in whom progressive scoliosis was noted; other authors have described no effect on the spinal column. A controlled study has not been performed.

Methods: All patients with spastic CP treated with ITB between 1997 and 2003 at a single institution were reviewed. A total of 107 patients undergoing ITB for a minimum of 2 years were identified, of which 26 patients subsequently developed or had progression of scoliosis. Twenty-five age, gender, and gross motor function classification system (GMFCS) score-matched quadriplegic CP patients with scoliosis who did not receive ITB constituted the control group used to compare the rate of curve progression and pelvic obliquity.

Results: The average curve progression for the baclofen group after pump implantation was 16.3 degrees per year; and for the control group was 16.1 degrees per year. Both groups' curves progressed over time during growth (P = 0.001), but baclofen did not have an independent effect on curve progression (P = 0.181). Average pelvic obliquity for the 2 groups increased over time (P = 0.001), but there was no difference between the groups (P = 0.536). Twelve of 57 patients (21%) developed scoliosis after pump implantation during a mean of 3.6 years of follow-up. Thirty of 92 matched control patients (32%) not treated with ITB within the same time interval had scoliosis by maturity.

Conclusion: This study demonstrates that ITB has no significant effect on curve progression, pelvic obliquity, or the incidence of scoliosis when compared with an age, gender, and GMFCS score-matched control group of patients with spastic CP without ITB.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Baclofen / administration & dosage*
  • Baclofen / adverse effects*
  • Cerebral Palsy / complications
  • Cerebral Palsy / drug therapy
  • Cerebral Palsy / epidemiology*
  • Child
  • Child, Preschool
  • Disease Progression
  • Female
  • Humans
  • Injections, Spinal
  • Male
  • Retrospective Studies
  • Risk Factors
  • Scoliosis / chemically induced
  • Scoliosis / epidemiology*
  • Scoliosis / etiology
  • Time Factors

Substances

  • Baclofen