Let's answer such this question What is the Intrathecal Baclofen Pump Therapy (ITB)? How the Intrathecal Baclofen Pump Surgery performed? Who’s Candidate to Intrathecal Baclofen Pump Therapy? Which factors are important to decide to do Intrathecal Baclofen Pump Therapy Surgery? What are the risks of the Intrathecal Baclofen Pump Therapy Surgery?
Intrathecal Baclofen Therapy (ITB) is a treatment method for severe spasticity. Intrathecal Baclofen Therapy uses a Intrathecal drug (baclofen) that is delivered into the cerebrospinal fluid around the spinal cord (intrathecal). The drug is placed into a adjustable pump (baclofen pump) that is usually placed under the skin in abdominal area.
the adjustable pump of the Intrathecal Baclofen Pump therapy, delivers baclofen to the Intrathecal area through a small tube (catheter). Since the pump is adjustable, we can adjust (program) the pump by remote control to deliver the appropriate daily dose for the patient.
The most advantage of this surgery we have a test opportunity before the surgery, we do a intrathecal test dose to see how the patient’s respond to the drug when it is delivered in same way. After the test is done, if the result is satisfactory we decide to implant the pump.
The Intrathecal Baclofen Pump surgery is not a difficult procedure. The surgery is mostly done under general anesthesia. Firstly, the catheter must be implanted in to the spinal cord from lumbar area. After the C-arm (radiological) verification the other end of the catheter must be tunneled under the skin and connected to the pump which implanted in abdominal area (under the skin).
The best advantages such these operations are reversibility, adjustability and testability (all Neuromodulation approaches like Intrathecal Baclofen Pump, Spinal Cord Stimulation, Deep Brain Stimulation, Sacral Stimulation, and Vagal Stimulation and are reversible interventions, therefore they never result with permanent damage)
The Intrathecal Baclofen Pump needs to be refilled at regular intervals (usually every 4 to 9 months it’s depends to the dosage, the dosage depends to the patient's spasticity degree). The refilling of the Intrathecal pum is an easy procedure. We can refill the Baclofen pump by a needle.
If the patient’s Spasticity so severe
If the spasticity interferes the movement of the extremities or prevent the patient’s care
If there is no response to medical treatment
If the test attempt is positive.
The most important factors are;
If the Conservative therapies (medical theapy or physical therapy and rehabilitation) have failed.
If there isn’t any benefit possibility from additional surgery.
If the patient and the physicians are satisfied from the test attempt result.
we can say that; the patient is a good candidate for Intrathecal Baclofen Pump Therapy surgery.
General complications of any surgeries are infection, bleeding, and reactions to anesthesia. In experienced hands the complications of the Intrathecal Baclofen Pump Therapy surgery is very low. Intrathecal Baclofen Pump Therapy surgery may also cause to cerebrospinal fluid leak, a pocket of clear fluid (seroma) at the implant site, catheter migration, which can result in changes in reduction in spasticity. In that point the evaluation of the patient before the surgery by an experienced team and the experiences of the surgeon is crucial.
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