Intrathecal baclofen in tetraplegia of spinal origin: Efficacy for upper extremity hypertonia

Abstract

Study design: Retrospective analysis. Objectives: To evaluate the efficacy of intrathecal baclofen (ITB) for upper extremity spastic hypertonia in tetraplegia of spinal origin. Setting: University of Alabama at Birmingham hospital. Methods: The medical records of 14 individuals with tetraplegia of spinal origin who underwent intrathecal baclofen pump placement were reviewed. The effects of intrathecal baclofen on spasm frequency, deep tendon reflexes, and tone (Ashworth scale) were assessed for the upper and lower extremities for a 1-year follow-up period. Results: There were statistically significant declines in upper extremity spasm scores (1.8 points, P= 0.012), reflex scores (1.4 points, P < 0.0001) and Ashworth scores (0.6 points, P<0.0001) for the 1-year follow-up period. For the lower extremities, all decreases were significant (P < 0.0001). There was also a statistically significant (P < 0.0001) increase in intrathecal baclofen dosage requirements during the 1-year follow-up period to maintain the reductions in spasm frequency, reflexes and tone. Conclusions: Intrathecal baclofen is a safe and effective intervention for treating upper extremity hypertonia of spinal origin. In addition, the level of intrathecal catheter placement is felt to be of importance.