Low Transverse Abdominal Incision for Subfascial Baclofen Pump Placement

Introduction: Baclofen pumps are associated with long scars that can be distressing to some patients.  At our institution, pumps are placed through low transverse abdominal incisions that lead to less noticeable scars than do other incisions. This study compares complication rates and efficacy of pumps placed through low transverse incisions versus through other incisions.

Methods: This retrospective study included all patients who underwent new subfascial pump implantation at Children’s Hospital Colorado 2000 through 2019. We examined the rates of all complications of intrathecal baclofen therapy, not just surgical, and examined preoperative and 1-year-postoperative modified Ashworth scale (MAS) scores. These values were compared between patients who underwent subfascial implantation through low transverse incisions versus through other incisions. Notable exclusions were pumps implanted through preexisting scars and pumps filled with medications other than baclofen. We also describe our surgical technique.

Results: Overall, 124 complications were reported in 160 pump implants (77.5%).  The complication rate was 79.6% (n=86) after 108 low transverse incisions and 73.1% (n=38) after 52 other incisions (p=0.323). The rate of infection/wound breakdown was 19.4% (n=21) with low transverse incisions and 19.2% (n=10) with other incisions (p=0.974). The rate of complications involving the pump was 7.40% (n=8) with low transverse incisions and 13.5% (n=7) with other incisions (p=0.168). The rate of complications involving the catheter was 45.4% (n=49) with low transverse incisions and 36.5% (n=19) with other incisions (p=0.290).  The mean reduction in MAS score was 0.22 in patients who had low transverse incisions and 1.20 in patients who had other incisions (p < 0.001).

Conclusion : Low transverse abdominal incisions are associated with similar overall complication rates to other baclofen pump incisions. We are not sure why low transverse incisions would be associated with less improvement in tone. Low transverse incisional scars are less noticeable than other incisional scars, which may improve patient satisfaction.