Comparison of intrathecal baclofen pump insertion and selective dorsal rhizotomy for nonambulatory children with predominantly spastic cerebral palsy

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  • 1 Division of Neurosurgery, Department of Surgery, Faculty of Medicine, and
  • | 2 Department of Medical Imaging, Faculty of Medicine, University of Toronto, Ontario;
  • | 3 Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital, Montreal, Quebec;
  • | 4 Brain and Child Development Axis, CHU Sainte-Justine Research Center, Montreal, Quebec;
  • | 5 Division of Orthopedic Surgery, Hospital for Sick Children, Toronto, Ontario;
  • | 6 Division of Developmental Paediatrics, Department of Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Ontario;
  • | 7 Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada;
  • | 8 Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana;
  • | 9 Department of Pediatrics and
  • | 10 Department of Physical Medicine and Rehabilitation and Neurosurgery, Baylor College of Medicine, Houston, Texas
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OBJECTIVE

In nonambulatory children with predominantly spastic cerebral palsy (CP), the authors compared care needs, symptom burden, and complications after surgical treatment with either intrathecal baclofen (ITB) pump insertion or selective dorsal rhizotomy (SDR). The patients were treated at two Canadian centers with variability in practice pertaining to these surgical options.

METHODS

The authors performed a retrospective analysis of nonambulatory children with predominantly spastic quadriplegic or diplegic CP who underwent treatment with ITB or SDR. These two strategies were retrospectively assessed by comparing patient data from the two treatment groups for demographic characteristics, outcomes, and complications. A partial least-squares analysis was performed to identify patient phenotypes associated with outcomes.

RESULTS

Thirty patients who underwent ITB and 30 patients who underwent SDR were included for analysis. Patients in the ITB group were older and had lower baseline functional status, with greater burdens of spasticity, dystonia, pain, deformity, bladder dysfunction, and epilepsy than patients in the SDR group. In addition, children who underwent SDR had lower Gross Motor Function Classification System (GMFCS) levels and were less likely to experience complications than those who underwent ITB. However, children treated with SDR had fewer improvements in pain than children treated with ITB. A single significant latent variable explaining 88% of the variance in the data was identified.

CONCLUSIONS

Considerable baseline differences exist within this pediatric CP patient population. Factors specific to individual children must be taken into account when determining whether ITB or SDR is the appropriate treatment.

ABBREVIATIONS

CP = cerebral palsy; GMFCS = Gross Motor Function Classification System; HSC = Hospital for Sick Children; ITB = intrathecal baclofen; PLS = partial least squares; SDR = selective dorsal rhizotomy; SJH = Sainte-Justine Hospital.

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