Simultaneous Selective Dorsal Rhizotomy and Baclofen Pump Removal Improve Ambulation in Patients with Spastic Cerebral Palsy

Abstract

BACKGROUND Intrathecal baclofen (ITB) administration via an implanted programmable pump and selective dorsal rhizotomy (SDR) are both used for the treatment of cerebral palsy (CP) spasticity. OBJECTIVE To examine whether SDR can improve ambulation in children who have been receiving ITB therapy for spastic cerebral palsy. METHODS We reviewed 13 patients who received prior ITB placement with subsequent simultaneous SDR and ITB removal. Patients also completed a follow-up survey to document long-term motor function. RESULTS In our 13-patient cohort, patients received ITB treatment for an average of 4.4 [Formula: see text] 1.8 years and the mean age of ITB removal/SDR was 12.5 [Formula: see text] 5.8 years. The follow-up period ranged from 3 to 19 months (mean duration: 6.9 [Formula: see text] 5 months). Pre-operatively, all patients had Gross Motor Function Classification System (GMFCS) scores between 2 and 4. Nine patients were diagnosed with spastic diplegia, two had spastic triplegia and two had spastic quadriplegia. SDR and ITB removal led to improved lower limb spasticity and ambulation. GMFCS scores remained stable in all patients. One patient developed a cerebrospinal fluid (CSF) collection in the abdominal wall due to a CSF leak from the baclofen pump site. All 11 patients who completed the follow-up survey noted improved motor function. CONCLUSION This study demonstrates that SDR can reduce spasticity and improve mobility after years of ITB treatment for spastic cerebral palsy.