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What is it?
Baclofen pump implantation is a surgical procedure performed to permanently implant a pump that delivers baclofen to the spinal fluid to treat severe to moderate-severe spasticity that is refractory to oral medications. It continuously delivers baclofen in small doses directly to the spinal fluid, increasing the therapeutic benefits, and causing fewer and less severe side effects compared to the oral medicine.
What is its goal?
The aim of the operation is to decrease spasticity related to multiple sclerosis, spinal cord injuries, or other neurological diseases.
How is it done?
During a pre-operative trial, baclofen is injected into the spinal canal (using a small needle) and you are assessed by the treatment team over several hours to determine how well the medicine treats the spasticity. If a positive effect is observed then you may be a candidate for implantation of a permanent pump to delver the drug.
The pump is inserted under the covering of the abdominal muscles while the patient is under a general anesthetic. A small catheter is then inserted through a needle into the spinal fluid space and is threaded upward. The catheter is then tunneled under the skin to the abdomen and is connected to the pump. The pump is filled with the drug baclofen and is programmed by a computer to continuously release a specified dose that is determined by the physician.
The operation is completed when the incision is closed with suture material (stitches) or surgical staples. If the outer incision is closed with staples or non-absorbable sutures, they will have to be removed after the incision has healed. The procedure usually lasts 1-2 hours.
What are the risks?
There are always risks with any surgery. Potential complications may include:
- Pain, numbness, weakness or paralysis due to nerve damage (rare)
- Cerebrospinal fluid leak
- Bleeding/injury to blood vessels
- General anesthetic complications
Hardware related complications during surgery is rare but can include catheter migration. After surgery though, the potential hardware complications include: catheter fracture or migration, infection or pump malfunction.
What is the success rate?
The success rate of baclofen pump implantation for delivery of baclofen to the spinal fluid is generally favorable. Patients tend to have had a good response from pre-operative trials of intrathecal (delivery to the spinal fluid) baclofen and this is the permanent implantation phase.
How long will I stay in the hospital?
After the surgery, patients are in the hospital for a few days. Each individual patient's return to normal activity is largely dependent on his/her pre-operative condition and age. Typically you will be able to go home once your vital signs are stable and you are back to baseline functioning. Follow-up will be needed as the pump will need to be refilled every couple of months, depending on the pump size, concentration and dose. Refills are done in the office using a syringe and needle and take approximately fifteen minutes to complete. At that time, baclofen doses are adjusted depending on the effects that are being seen.