Abstract：
Intrathecal baclofen (ITB) is an effective treatment for hypertonia in children involving the implantation of a pump and catheter system. The highest concentration of ITB is at the catheter tip. The catheter tip location is most commonly within the lumbar or thoracic spine. The cervical tip location has traditionally been avoided because of concerns of hypoventilation and pneumonia; however, these complications in cervical compared with thoracic or lumbar placement have not been reliably proven. Some studies have suggested that cervical ITB location better treats upper-extremity hypertonia. There are limited data describing the safety and efficacy of cervical ITB on hypertonia. The authors present a single-institution retrospective case series highlighting the safety and efficacy of using cervical ITB location for the treatment of hypertonia.
Retrospective data analysis was performed for children who underwent continuous dosing cervical ITB between April 2022 and October 2023. Nonmodifiable risk factors, clinical variables, operative characteristics, and adverse outcomes were collected.
This study included 25 patients (8 female). The mean age at implantation was 12.4 years, and the mean operative duration was 90 minutes. The mean Barry-Albright Dystonia Scale score decreased by 9.5 points (p = 0.01). The mean aggregated modified Ashworth scale score in the upper extremities decreased by 2.14 points (p = 0.04), and that in the lower extremities decreased by 4.98 points (p < 0.01). One patient each (4%) had infection and baclofen toxicity. Two patients (8%) had respiratory depression requiring continuous positive airway pressure. There was no incidence of pneumonia or wound dehiscence.
The cervical catheter tip location for ITB is safe, is effective to control tone, and should be considered for the treatment of hypertonia. Larger studies with longer follow-up are necessary to further determine upper-limit dosing safety along with long-term functional benefits in these patients.
Retrospective data analysis was performed for children who underwent continuous dosing cervical ITB between April 2022 and October 2023. Nonmodifiable risk factors, clinical variables, operative characteristics, and adverse outcomes were collected.
This study included 25 patients (8 female). The mean age at implantation was 12.4 years, and the mean operative duration was 90 minutes. The mean Barry-Albright Dystonia Scale score decreased by 9.5 points (p = 0.01). The mean aggregated modified Ashworth scale score in the upper extremities decreased by 2.14 points (p = 0.04), and that in the lower extremities decreased by 4.98 points (p < 0.01). One patient each (4%) had infection and baclofen toxicity. Two patients (8%) had respiratory depression requiring continuous positive airway pressure. There was no incidence of pneumonia or wound dehiscence.
The cervical catheter tip location for ITB is safe, is effective to control tone, and should be considered for the treatment of hypertonia. Larger studies with longer follow-up are necessary to further determine upper-limit dosing safety along with long-term functional benefits in these patients.
摘要：
目的：鞘内注射巴氯芬（ITB）是治疗儿童高张力的有效方法，涉及泵和导管系统的植入。ITB的最高浓度在导管尖端。导管尖端位置最常见的是在腰椎或胸椎内。由于担心通气不足和肺炎，传统上避免了宫颈尖端位置；但是，与胸部或腰椎放置相比，颈椎的这些并发症尚未得到可靠证实。一些研究表明，宫颈ITB位置更好地治疗上肢高渗症。描述宫颈ITB对高渗症的安全性和有效性的数据有限。作者提出了一个单机构回顾性病例系列，强调了使用宫颈ITB位置治疗高张力的安全性和有效性。
方法：对2022年4月至2023年10月期间连续给药宫颈ITB的儿童进行回顾性数据分析。不可改变的危险因素，临床变量，手术特征，并收集不良结局.
结果：本研究包括25名患者（8名女性）。植入时的平均年龄为12.4岁，平均手术时间为90分钟。平均Barry-Albright肌张力障碍量表评分下降9.5分(p=0.01)。上肢改良Ashworth量表的平均总评分下降了2.14分（p=0.04），下肢下降4.98分(p<0.01)。每个患者（4％）有感染和巴氯芬毒性。两名患者（8％）有呼吸抑制，需要持续气道正压通气。没有肺炎或伤口开裂的发生率。
结论：ITB的宫颈导管尖端位置是安全的，有效控制音调，应考虑用于治疗高张力症。需要进行更大的研究和更长时间的随访，以进一步确定这些患者的上限给药安全性以及长期功能益处。
方法：对2022年4月至2023年10月期间连续给药宫颈ITB的儿童进行回顾性数据分析。不可改变的危险因素，临床变量，手术特征，并收集不良结局.
结果：本研究包括25名患者（8名女性）。植入时的平均年龄为12.4岁，平均手术时间为90分钟。平均Barry-Albright肌张力障碍量表评分下降9.5分(p=0.01)。上肢改良Ashworth量表的平均总评分下降了2.14分（p=0.04），下肢下降4.98分(p<0.01)。每个患者（4％）有感染和巴氯芬毒性。两名患者（8％）有呼吸抑制，需要持续气道正压通气。没有肺炎或伤口开裂的发生率。
结论：ITB的宫颈导管尖端位置是安全的，有效控制音调，应考虑用于治疗高张力症。需要进行更大的研究和更长时间的随访，以进一步确定这些患者的上限给药安全性以及长期功能益处。
