Painspasticity

Pediatric neurosurgery has witnessed significant minimally invasive advances in the treatment of spasticity. Although it is still being performed, selective dorsal rhizotomy has seen a marked falloff in favor of the insertion of baclofen pumps. In these procedures, a lumbar puncture or lumbar drain is performed to allow for a test dose of intrathecal baclofen. If this is successful, the definitive implanted pump can then be inserted by implanting a lumbar catheter, which is then tunneled subcutaneously and attached to a small, refill-able pump placed in the subcutaneous space in the abdominal wall. Depending on the level of spasticity, the cathether tip can be placed all the way up to the cervical region from the lumbar space (24). Intrathecal baclofen pump implantation has improved quality of life and helped to reduce the need for the multiple orthopedic procedures that are often performed to release contracted tendons and "locked" joints in the patients with severe spasticity.

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