Cervical Catheter Placement for Continuous Intrathecal Baclofen: A retrospective case series

Introduction: Intrathecal Baclofen (ITB) is an effective treatment for hypertonia in children involving the implantation of a pump and catheter system. ITB catheter tip placement is commonly placed at the lumbar or thoracic spine. Cervical tip placement has traditionally been avoided due to concerns of hypoventilation and pneumonia; yet some studies suggest cervical placement optimally treats upper extremity hypertonia. There are limited safety and efficacy data in the treatment of hypertonia with cervical ITB catheter tip. A longitudinal cohort was identified to highlight our institutional safety and efficacy using cervical ITB tip placement for the treatment of hypertonia.

Methods: Retrospective data analysis was performed for children that underwent ITB placement with a cervical catheter tip between 2021-2023. Non-modifiable risk factors, clinical variables, and operative characteristics were collected.

Results: 24 patients (7 female) had 25 procedures. Mean age at implantation was 12.3 years, mean operative duration was 90 minutes. The mean Barry Albright dystonia scale (BADS) decreased by 9.33 points (p= 0.01) at 4 hours post-op. Mean upper extremity modified Ashworth scale (mAS) decreased by 2.46 points and mean lower extremity mAS decreased by 4.8 (p=0.03, p< 0.001). Infection was diagnosed in 1/24 (4.2%) patients and respiratory depression requiring CPAP was also seen in 4.2% of patients. There was no incidence of pneumonia or wound dehiscence. Long-term functional outcomes are not available yet.

Conclusion : Cervical catheter tip placement for ITB is safe and effective and should be considered for the treatment of hypertonia. Larger studies with longer follow-up are necessary to further determine safety along with long-term functional benefits in these patients.