RESUMO
Intrathecal baclofen (ITB) therapy is used to treat patients with spasticity. The pump that delivers baclofen to the intrathecal space of the thoracolumbar spine is generally implanted under the skin or fascia of the anterolateral abdomen. Here we present a case in which the pump was implanted in an alternative site, under the skin of the anteromedial thigh. The patient was a 61-year-old man who was 148 cm tall. He had spastic paraplegia (ASIA Impairment Scale grade B) caused by severe scoliosis related to dystrophic neurofibromatosis. No safety space for pump implantation existed in his abdomen because of a stoma, scars, and adhesions that resulted from surgeries for ileus and abdominal aortic aneurysms. The catheter ran from the lumbar spine to the anteromedial thigh via the point between the iliac crest and the great trochanter. The catheter and pump caused no trouble over 1 year of follow-up. This case demonstrates that the thigh can be an alternative site for ITB pump implantation in some patients with abdominal wall problems. This surgical modification may not be indicated for some patients with ambulators or frequent hip motion, who are at risk of catheter problems or pump migration.
RESUMO
Intrathecal baclofen (ITB) therapy is used to treat patients with spasticity. The pump that delivers baclofen to the intrathecal space of the thoracolumbar spine is generally implanted under the skin or fascia of the anterolateral abdomen. Here we present a case in which the pump was implanted in an alternative site, under the skin of the anteromedial thigh. The patient was a 61-year-old man who was 148 cm tall. He had spastic paraplegia (ASIA Impairment Scale grade B) caused by severe scoliosis related to dystrophic neurofibromatosis. No safety space for pump implantation existed in his abdomen because of a stoma, scars, and adhesions that resulted from surgeries for ileus and abdominal aortic aneurysms. The catheter ran from the lumbar spine to the anteromedial thigh via the point between the iliac crest and the great trochanter. The catheter and pump caused no trouble over 1 year of follow-up. This case demonstrates that the thigh can be an alternative site for ITB pump implantation in some patients with abdominal wall problems. This surgical modification may not be indicated for some patients with ambulators or frequent hip motion, who are at risk of catheter problems or pump migration.
RESUMO
Longer-term results of Orthopaedic Selective Spasticity-Control Surgery (OSSCS) on gross motor function in 25 patients with cerebral palsy were investigated and compared to the natural history of 70 non-surgical patients with brain-related disabilities, who were visiting this center, in GML using longitudinal and stratified analysis. Participants were 9 females and 16 males, who had previously undergone OSSCS at 13.1 years (5.3 to 38.9) on the average. There were 8, 2, 3, 5, and 7 patients from level 1 to 5 in the Gross Motor Function Classification System (GMFCS), respectively. Gross Motor Function Measure (GMFM) and Gross Motor Level (GML) were evaluated at pre-operation, one year after surgical intervention and every year thereafter. The average passage observation period was 6.4 years (3.7 to 8.4). A good one year postoperative outcome was obtained in 25 cases (100%) in GML and 23 (92%) in GMFM. Good maintenance was recognized in 22 cases (88%) in GML and 17 cases (68%) in GMFM as observed by postoperative progress. The gross motor function began to deteriorate from around 20 years of age in the no-operation group and experienced a drop for many cases in their late thirties. Even this ages, all of 8 patients of operative group with this ages maintained good results in GML. From these results, we found that OSSCS is an effective surgical intervention and that its effect was maintained for many cerebral palsy cases for the postoperative middle term.