Intrathecal Baclofen Therapy in a Child With Severe Scoliosis: Report of 2 Cases

Objective Scoliosis is commonly found in children with cerebral palsy. Many patients with cerebral palsy and scoliosis undergo intrathecal baclofen (ITB) pump placement. The authors report 2 cases with cerebral palsy and severe scoliosis treated with intrathecal baclofen. Method The case of a 7-year-old boy with shunted hydrocephalus required surgical revision of the intrathecal catheter, while the other patient without shunt did not require revision. In the patient with shunted hydrocephalus, after the initial placement of baclofen pump and catheter at Th3 level, spasticity of lower extremities did not improve. The Indium111 diethylenetriamine pentaacetic acid (In111 DTPA) scintigraphy with injection of In111 DTPA through the pump did not demonstrate distribution of the tracer to the lumbosacral area. Conversely, by direct injection of In111 DTPA through lumbar puncture, the tracer distributed in the whole spinal canal. Result Replacement of the tip of the catheter caudal to the curve of the scoliosis improved the symptom. Conclusion The authors suggest that, in patients with severe scoliosis and shunted hydrocephalus, it may be necessary to place the tip of the catheter caudal to the curve of the scoliosis for correction of spasticity of lower extremities.