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Sasha C. Burn, Reinhard Zeller and James M. Drake

given intrathecally, were much higher than when given orally (380 ng/ ml rather than 12–95 ng/ml 1 ) and it was clinically more effective. Plasma levels after intrathecal administration of baclofen are extremely low, thereby reducing side effects. To establish an intrathecal delivery system intrathecal pumps were adapted from pumps used to infuse opioids in cancer patients and the first intrathecal baclofen pumps were implanted in 1985. The range of management options for spasticity includes oral medications, treatment for focal spasticity such as botulinum toxin

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Virendra R. Desai, Jeffrey S. Raskin, Arvind Mohan, JoWinsyl Montojo, Valentina Briceño, Daniel J. Curry and Sandi Lam

I ntrathecal baclofen pumps are placed for dystonia and spasticity with high efficacy. 3 , 8 Infection rates and complication rates related to baclofen pumps are reported to range from 3% to 41.7%. 16 , 25 Reported risk factors include low body mass index (BMI), presence of a gastrostomy tube, scoliosis, and other comorbidities. 13 , 25 A majority of infections occur within 60 days of surgery: the infection rates are 4.0% in the first 60 days and 1.0% per year thereafter. 1 , 6 , 13 Various techniques have been reported with the goal of infection prevention

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Amer Dastgir, Nathan J. Ranalli, Theresa L. MacGregor and Philipp R. Aldana

. Symptoms can include but are not limited to dizziness, disorientation, agitation, hypertonia, spasticity, rigidity, and seizures. Baclofen withdrawal symptoms can be minimized by tapering down the medication. 27 Malfunction of the pump hardware and catheter (21%–33%) and infection (9%–10%) are the most common complications in patients. Catheter-related problems are the most common cause of hardware malfunction. 5 , 7 , 8 , 16 , 44 Case Report History and Examination This 15-year-old male patient with a history of cerebral palsy had an intrathecal baclofen pump

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Sydney M. Hester, John F. Fisher, Mark R. Lee, Samuel Macomson and John R. Vender

and indications for vacuum-assisted wound closure continue to increase, studies addressing the adaptability of this technique to ITB infections would also be of interest. 3 , 12 , 27 , 28 Conclusions Intrathecal baclofen pump infections will continue to be a problem for medical and surgical specialists as the use of this technology continues to increase. In general, local wound care and appropriate oral antibiotics and close follow-up are sufficient for suspected or superficial infections involving the baclofen pump site. However, the patient's growth and

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Jonathan Dallas, Katherine D. Sborov, Bradley S. Guidry, Silky Chotai and Christopher M. Bonfield

scoliosis, a number of patients undergo ventricular shunt (VS) and/or intrathecal baclofen pump (BP) placement and subsequent spinal fusion. Recent studies and case reports have shown a possible relationship between spinal fusion and increased implant failure in patients with preexisting implants. 1 , 4 , 6 , 7 , 9–12 , 15 , 18 Common causes of implant failures include infection, malfunction, obstruction, and catheter fracture. 2 , 16 A number of hypotheses have been proposed to explain a relationship with spinal fusion; for example, causes of shunt failure have been

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Heather S. Spader, Robert J. Bollo, Christian A. Bowers and Jay Riva-Cambrin

I ntrathecal baclofen (ITB) therapy has been used to treat spasticity in adults since the 1980s and in children since 1993, when Albright and colleagues 1 published their findings on the first series of 37 pediatric patients implanted with baclofen pumps. In that series, the authors found an overall infection rate of 19% without perioperative antibiotics and 5% with perioperative antibiotics. Subsequent studies have found infection rates in children with baclofen pumps that range from 3% to 40%, although most studies report an infection rate of

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R. Shane TUBBS, Charles Law, W. Jerry Oakes and Paul A. Grabb

B aclofen pumps are frequently used in the treatment of spasticity. Although many complications have been reported, an acquired Chiari I malformation resulting from a baclofen pump system has not been reported in the literature. We review the case of baclofen pump—induced Chiari I malformation and review the pertinent literature. Case Report History and Treatment We report the case of a 13-year-old boy, born at 28 weeks' gestation, who weighed approximately 900 g and suffered from an intraventricular hemorrhage. Hydrocephalus was soon diagnosed. At

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Zaid Aljuboori, Jacob Archer, Wei Huff, Amee Moreno and Andrew Jea

approaches to the craniocervical junction and cervical spine for placement of the baclofen catheter. The technique of C1–2 cisternal puncture has been well described and well practiced. 8 , 9 , 23 To the best of our knowledge, however, we report for the first time the use of C1–2 transfascial/transmuscular puncture of the thecal sac for placement of intrathecal baclofen pump catheters. Methods Patients Our 4 patients who underwent successful placement of intrathecal baclofen catheters through C1–2 access were 14, 5, 9, and 13 years old ( Table 1 ). There were 3 boys and 1

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James K. Liu and Marion L. Walker

C hildren with cerebral palsy often suffer from severe spasticity and dystonia, which results in discomfort and deformity, impedes their ability to perform functional skills, and increases the burden of care for their caregivers. Intrathecal baclofen pumps for the management of severe spasticity are being used more often in children with cerebral palsy. Several studies have demonstrated substantial reduction in muscle tone as well as improvement of function and ease of care with intrathecal baclofen therapy. 1–5, 7, 10 The intrathecal catheter is

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I-Wen Pan, Grace M. Kuo, Thomas G. Luerssen and Sandi K. Lam

T he intrathecal baclofen pump (ITBP) was first introduced for treatment of spasticity of spinal origin. 13 The surgery involves the implantation of a permanent intrathecal catheter, reservoir, and pump mechanism to allow instillation of medication. Infections are not uncommon with these surgeries, which involve the presence of implants in a patient population with complex medical conditions. Infection rates were reported in some studies to be 4.5%-9% or even higher in children (9%-12%). 3 , 5 A collaborative study among European countries for consensus