Pump/surgical treatments of spasticity

1. What are the benefits of using a baclofen pump over oral baclofen?
2. What sort of patients are good candidates for a baclofen pump?
3. What are problems associated with a baclofen pump?
4. What is the SPLATT procedure? What procedure is it usually accompanied by?
5. What other orthopedic procedures treat spasticity?
6. How does a dorsal rhizotomy prevent spasticity?

Answers:
1. The pump is implanted in the subarachnoid space and delivers baclofen directly into the CSF, allowing high doses of baclofen without unwanted CNS side effects.
2. The pump is indicated for patients with diffuse, generalized spasticity with poor response to conservative treatment. Traditionally used in patients with spinal spasticity, SCI, MS, CP.
3. Tube dysfunction, pump failure, infection, dosage error, skin breakdown, spinal headache. Side effects of baclofen itself include drowsiness, headaches, dizziness, nausea, hypotension, weakness. Seizures, respiratory depression, and LOC can occur with overdose.
4. SPLATT (split anterior tibial tendon transfer) is used for treatment of equinovarus foot deformity (foot plantarflexed, inverted, and supinated). The tib ant muscle is split and the distal end is attached to the cuboid and third cuneiform bones, creating an eversion force. It is usually done in conjunction with tendo-Achilles lengthening.
5. Tendon transfers, tendon release, step-cut (Z-plasty) lengthening, tenotomy, myotomy.
6. Dorsal rhizotomy involves neurosurgical sectioning of selected dorsa; segmental roots to modulate afferent sensory input and reset muscle spindles so there is less spasticity.