Intrathecal Baclofen: Our Experience in Neuromodulation of Spasticity in Traumatic Spinal Cord Injury Patients

Aims and Objective:. Spasticity develops invariably over the period of few months in patients of spinal cord injury(SCI). The subgroup of patients who become ambulant after the rehabilitation period are severely disabled after the development of spasticity and may become bed bound. Our aim was to describe the use of intrathecal baclofen therapy with implantation of baclofen pump in improving the QoL. Material and Methods: Ours is a referral centre of Indian Armed Forces for the comprehensive management of patients sustaining traumatic SCI. 5 patients of traumatic spinal cord injury who developed disabling spasticity and underwent baclofen pump implantation for intrathecal delivery of baclofen after failure of oral medications were included in this study. The period of study was Jan 2017 to Jun 2019. All the 5 patients had modifies Ashworth grade 4 spasticity at the time of the implantation of the device. Results: All 5 patients had significant improvement for the spasticity and became ambulant again which was hampered by the development of severe spasticity. 1 patient had transient hypotension lasting for 7 days which resolved spontaneously without any intervention. 1 patient developed implant related infection which was initially manage with antibiotics but eventually required removal of the implanted device. During the follow up period (5 ? 27 months good control of spasticity has been maintained in the 4 patients with improvement on overall QoL. Conclusions: ITB delivery through implantation of delivery device is a definitive option in pateints of SCI who develop disabling spasticity restricting the patients mobility and affecting overall QoL. The most important advantage of this modality is that it is a reversible procedure and drug delivery dosage can be titrated according to patients requirement, which is not possible in patient undergoing DREZotomy. The complication related to the drug/device are few and can be managed adequately.