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Does the Addition of Intrathecal Baclofen Along with or After Soft-Tissue Hip Adductor Surgery Decrease the Need for Hip Reconstruction Compared with Soft-Tissue Surgery Alone for Children with Nonambulatory Cerebral Palsy?

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Abstract

Purpose

Intrathecal baclofen (ITB) is a well-known treatment option for cerebral palsy (CP) spasticity. The combination of soft-tissue release and ITB for spasticity is common. This study compared patients who had soft-tissue release before ITB (PRE-ITB), soft-tissue release at the same time as ITB (ST-ITB), and no ITB (NON-ITB) but had soft-tissue release at a similar age as PRE-ITB.

Methods

Inclusion criteria were a spastic or mixed nonambulatory CP diagnosis, prior hip adductor surgery, no prior reconstructive surgery, and at least a five-year post-operative follow-up. Thirty hips were identified as PRE-ITB, 20 hips as ST-ITB, and 43 hips as NON-ITB. The primary outcome variables were the subsequent hip surgery during the study period and/or a migration percentage ≥ 50% at the final follow-up defined as “unsuccessful hip.”

Results

The mean follow-up duration was 9.0 years (SD 2.4) for PRE-ITB, 9.4 (SD 3.6) for ST-ITB, and 9.3 (SD 3) for NON-ITB. The odds of unsuccessful outcomes were not different between NON-ITB and PRE-ITB but were lower for the ST-ITB group. The need for subsequent osteotomies or revision adductor surgery was significantly higher in ST-ITB compared with PRE-ITB (p = 0.02) or NON-ITB (p = 0.015). The incidence of surgical site infection over the whole follow-up period was higher in ST-ITB (40%) compared with PRE-ITB (13.3%, p = 0.035) and NON-ITB (0, p < 0.001).

Conclusion

The addition of tone management with ITB did not reduce the need for later hip surgery but did increase the risk for surgical site infection.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics, Nemours Children’s Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Ali Asma, Armagan Can Ulusaloglu, Jason J. Howard, Kenneth J. Rogers, Freeman Miller & Michael Wade Shrader

  2. Investigation Performed at Nemours Children’s Hospital, Wilmington, DE, USA

    Ali Asma, Armagan Can Ulusaloglu, Jason J. Howard, Kenneth J. Rogers, Freeman Miller & Michael Wade Shrader

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  1. Ali Asma
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection and analysis were performed by AA, ACU, JJ H, KJR, FM, and MWS. The first draft of the manuscript was written by AA, ACU, JJH, and KJR. Critical revision for important intellectual content was made by AA, ACU, JJH, KJR, FM, and MWS. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michael Wade Shrader.

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Conflict of interest

Ali Asma, Armagan Can Ulusaloglu, Jason J. Howard, Kenneth J. Rogers, Freeman Miller, and Michael Wade Shrader declare that they have no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Nemours Office of Human Subjects Protection Institutional Review Board.

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Asma, A., Ulusaloglu, A.C., Howard, J.J. et al. Does the Addition of Intrathecal Baclofen Along with or After Soft-Tissue Hip Adductor Surgery Decrease the Need for Hip Reconstruction Compared with Soft-Tissue Surgery Alone for Children with Nonambulatory Cerebral Palsy?. JOIO 56, 2176–2181 (2022). https://doi.org/10.1007/s43465-022-00762-w

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