PROGRESSION OF SCOLIOSIS IN SPASTIC QUADRIPLEGIA AFTER INTRATHECAL BACLOFEN PUMP INSERTION

Glen M. Ginsburg, MD;
Anthony J. Lauder, MD
Omaha, NE, USA

The authors noted a trend of significant scoliosis progression in children after the insertion of an intrathecal Baclofen pump. To verify this trend, the charts and radiographs of 36 non-ambulatory patients with spastic quadriplegia and a functioning Baclofen pump were reviewed. Of these patients, 18 had at least one pre- and post-pump insertion radiograph taken in the same position (supine). The average Cobb angle before pump insertion was 11.1° (0° - 21.1°) and after insertion was 22.8° (0° - 64.7°) with p=0.0003 by Wilcoxon signed-rank test. 11 patients had at least 2 pre- and post-pump insertion radiographs. The median rate of change in Cobb angle prior to pump insertion was 2.56°/year (-2.46° - 43.8°) and after pump insertion was 18.25° (-18.25°/year - 43.8°/year) with p=0.024 by Wilcoxon signed-rank test. The average published progression of scoliosis in skeletally mature (Risser 5), non-ambulatory patients with spastic quadriplegia was 2.4°/year (n=4). The comparable rate of change in skeletally mature (Risser 5) non-ambulatory patients in this study was 27.5°/year (n=4), or an 11-fold in curve progression over the published natural history.