{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:10:36Z","timestamp":1792195836931,"version":"4.4.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The aim of this study was 1) to describe the rate of intrathecal baclofen (ITB)\u2013associated complications at a large tertiary center, and 2) to evaluate the impact of patient-related factors on the likelihood of developing such complications.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A retrospective single-center study was carried out. A total of 301 eligible patients were included in the analysis. Univariate regression models were used to evaluate the impact of age, sex, diagnosis, ambulation status, modified Ashworth scale score, body mass index, diabetes status, and pain level on the likelihood of developing a device-related infection, pump malfunction, catheter malfunction, and other clinically significant complications.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Overall, 27% of patients experienced an ITB-related complication. The most common complications included infection (6%, 18\/301), pump malfunction (7.3%, 22\/301), and catheter malfunction (14%, 42\/301). The univariate analyses revealed that the patient\u2019s ambulatory status had a significant impact on the likelihood of developing a catheter-related malfunction. Furthermore, a trend toward significance was identified between patients\u2019 preoperative body mass index and device-related infection. Finally, the risk of suffering any ITB-related complications was statistically correlated with the number of years that had passed since the initial pump implantation.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The authors\u2019 analysis reveals a previously underrecognized association between ambulatory status at the time of ITB pump implantation and the incidence of catheter-related complications, and confirms the impact of time since surgery on the risk of developing any ITB-related complication. The patient\u2019s age, sex, diagnosis, diabetes status, or pain level at baseline were not associated with the risk of complications. Collectively, these insights contribute novel information to the existing literature, providing practical value for physicians in guiding patient selection for ITB therapy.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.3.focus2471","type":"journal-article","created":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T05:42:54Z","timestamp":1717220574000},"page":"E12","source":"Crossref","is-referenced-by-count":9,"title":["Uncovering the rate and risk factors of intrathecal baclofen pump\u2013associated complications in the adult population"],"prefix":"10.3171","volume":"56","author":[{"given":"Jakov","family":"Tiefenbach","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic Foundation, Cleveland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre G.","family":"Machado","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic Foundation, Cleveland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Bethoux","sequence":"additional","affiliation":[{"name":"Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland; and"},{"name":"Department of Physical Medicine & Rehabilitation, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Functional Neurosurgery and Neuromodulation.","first-page":"243","article-title":"Central and peripheral neurosurgical ablative techniques for hypertonia","author":"Ghany WAA","year":"2018","unstructured":"Ghany WAA, Nada MAR. Central and peripheral neurosurgical ablative techniques for hypertonia. In: Burchiel KJ, Raslan AM.Functional Neurosurgery and Neuromodulation.1st ed. Elsevier;2018:243-261."},{"key":"b2","series-title":"Rehabil Res Pract","first-page":"279175","article-title":"Clinical understanding of spasticity: implications for practice","volume":"2014","author":"Bhimani R","year":"2014","unstructured":"Bhimani R, Anderson L. Clinical understanding of spasticity: implications for practice. Rehabil Res Pract. 2014;2014:279175."},{"issue":"2","key":"b3","series-title":"Neurotherapeutics","first-page":"274","article-title":"Latest approaches for the treatment of spasticity and autonomic dysreflexia in chronic spinal cord injury","volume":"8","author":"Rabchevsky AG","year":"2011","unstructured":"Rabchevsky AG, Kitzman PH. Latest approaches for the treatment of spasticity and autonomic dysreflexia in chronic spinal cord injury. Neurotherapeutics. 2011;8(2):274\u2013282."},{"issue":"1-2","key":"b4","series-title":"Crit Rev Phys Rehabil Med","first-page":"11","article-title":"A review of spasticity treatments: pharmacological and interventional approaches","volume":"25","author":"Chang E","year":"2013","unstructured":"Chang E, Ghosh N, Yanni D, Lee S, Alexandru D, Mozaffar T. A review of spasticity treatments: pharmacological and interventional approaches. Crit Rev Phys Rehabil Med. 2013;25(1-2):11\u201322."},{"issue":"7","key":"b5","series-title":"Ont Health Technol Assess Ser","first-page":"1","article-title":"Medical Advisory Secretariat. Intrathecal baclofen pump for spasticity: an evidence-based analysis","volume":"5","year":"2005","unstructured":"Medical Advisory Secretariat. Intrathecal baclofen pump for spasticity: an evidence-based analysis. Ont Health Technol Assess Ser. 2005;5(7):1\u201393."},{"issue":"3","key":"b6","series-title":"Neurosurgery","first-page":"603","article-title":"Intrathecal baclofen for intractable cerebral spasticity: a prospective placebo-controlled, double-blind study","volume":"46","author":"Van Schaeybroeck P","year":"2000","unstructured":"Van Schaeybroeck P, Nuttin B, Lagae L, Schrijvers E, Borghgraef C, Feys P. Intrathecal baclofen for intractable cerebral spasticity: a prospective placebo-controlled, double-blind study. Neurosurgery. 2000;46(3):603\u2013612."},{"issue":"2","key":"b7","series-title":"BJA Educ","first-page":"51","article-title":"Complications associated with intrathecal drug delivery systems","volume":"20","author":"Delhaas EM","year":"2020","unstructured":"Delhaas EM, Huygen FJPM. Complications associated with intrathecal drug delivery systems. 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Clin Neurol Neurosurg. 2012;114(4):321\u2013325."},{"key":"b11","series-title":"World Neurosurg","first-page":"e59","article-title":"Infectious complications and operative management of intrathecal baclofen pumps in the pediatric population: a systematic review and meta-analysis of 20 years of pooled experience","volume":"163","author":"Nuru M","year":"2022","unstructured":"Nuru M, Maglinger B, Vessell M, Infectious complications and operative management of intrathecal baclofen pumps in the pediatric population: a systematic review and meta-analysis of 20 years of pooled experience. World Neurosurg. 2022;163:e59\u2013e72."},{"issue":"4","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"493","article-title":"Comparison between an Ascenda and a silicone catheter in intrathecal baclofen therapy in pediatric patients: analysis of complications","volume":"18","author":"Motta F","year":"2016","unstructured":"Motta F, Antonello CE. 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Evaluation of risk factors for cerebrospinal leakage in pediatric patients with cerebral palsy treated with intrathecal baclofen. J Pediatr Orthop. 2020;40(6):e522\u2013e526."},{"key":"b19","series-title":"World Neurosurg","first-page":"e456","article-title":"Intrathecal baclofen and opioid therapy: cerebrospinal fluid leak and infection incidence, risk factors, and outcomes","volume":"171","author":"Wilson C","year":"2023","unstructured":"Wilson C, Linczer J, Newman S, Intrathecal baclofen and opioid therapy: cerebrospinal fluid leak and infection incidence, risk factors, and outcomes. World Neurosurg. 2023;171:e456\u2013e463."},{"key":"b20","series-title":"Clin Neurol Neurosurg","first-page":"106630","article-title":"Complications of intrathecal drug delivery therapy (ITDD): a retrospective study of 231 implantations between 1999 and 2014","volume":"205","author":"Necking E","year":"2021","unstructured":"Necking E, Levi R, Ertzgaard P. Complications of intrathecal drug delivery therapy (ITDD): a retrospective study of 231 implantations between 1999 and 2014. Clin Neurol Neurosurg. 2021;205:106630."},{"issue":"23","key":"b21","series-title":"Eur Heart J","first-page":"1862","article-title":"Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982-2018)","volume":"40","author":"Olsen T","year":"2019","unstructured":"Olsen T, J\u00f8rgensen OD, Nielsen JC, Th\u00f8gersen AM, Philbert BT, Johansen JB. Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982-2018). Eur Heart J. 2019;40(23):1862\u20131869."},{"issue":"3","key":"b22","series-title":"J Leukoc Biol","first-page":"525","article-title":"Obesity and type 2 diabetes mellitus drive immune dysfunction, infection development, and sepsis mortality","volume":"104","author":"Frydrych LM","year":"2018","unstructured":"Frydrych LM, Bian G, O\u2019Lone DE, Ward PA, Delano MJ. Obesity and type 2 diabetes mellitus drive immune dysfunction, infection development, and sepsis mortality. J Leukoc Biol. 2018;104(3):525\u2013534."},{"issue":"1","key":"b23","series-title":"Open Forum Infect Dis","first-page":"ofaa545","article-title":"The association between body mass index and the risk of hospitalization and mortality due to infection: a prospective cohort study","volume":"8","author":"Yang WS","year":"2020","unstructured":"Yang WS, Chang YC, Chang CH, Wu LC, Wang JL, Lin HH. The association between body mass index and the risk of hospitalization and mortality due to infection: a prospective cohort study. Open Forum Infect Dis. 2020;8(1):ofaa545."},{"key":"b1","series-title":"Functional Neurosurgery and Neuromodulation.","first-page":"243","article-title":"Central and peripheral neurosurgical ablative techniques for hypertonia","author":"Ghany WAA","year":"2018","unstructured":"Ghany WAA, Nada MAR. Central and peripheral neurosurgical ablative techniques for hypertonia. In: Burchiel KJ, Raslan AM.Functional Neurosurgery and Neuromodulation.1st ed. Elsevier;2018:243-261."},{"key":"b2","series-title":"Rehabil Res Pract","first-page":"279175","article-title":"Clinical understanding of spasticity: implications for practice","volume":"2014","author":"Bhimani R","year":"2014","unstructured":"Bhimani R, Anderson L. Clinical understanding of spasticity: implications for practice. Rehabil Res Pract. 2014;2014:279175."},{"issue":"2","key":"b3","series-title":"Neurotherapeutics","first-page":"274","article-title":"Latest approaches for the treatment of spasticity and autonomic dysreflexia in chronic spinal cord injury","volume":"8","author":"Rabchevsky AG","year":"2011","unstructured":"Rabchevsky AG, Kitzman PH. Latest approaches for the treatment of spasticity and autonomic dysreflexia in chronic spinal cord injury. Neurotherapeutics. 2011;8(2):274\u2013282."},{"issue":"1-2","key":"b4","series-title":"Crit Rev Phys Rehabil Med","first-page":"11","article-title":"A review of spasticity treatments: pharmacological and interventional approaches","volume":"25","author":"Chang E","year":"2013","unstructured":"Chang E, Ghosh N, Yanni D, Lee S, Alexandru D, Mozaffar T. A review of spasticity treatments: pharmacological and interventional approaches. Crit Rev Phys Rehabil Med. 2013;25(1-2):11\u201322."},{"issue":"7","key":"b5","series-title":"Ont Health Technol Assess Ser","first-page":"1","article-title":"Medical Advisory Secretariat. Intrathecal baclofen pump for spasticity: an evidence-based analysis","volume":"5","year":"2005","unstructured":"Medical Advisory Secretariat. Intrathecal baclofen pump for spasticity: an evidence-based analysis. Ont Health Technol Assess Ser. 2005;5(7):1\u201393."},{"issue":"3","key":"b6","series-title":"Neurosurgery","first-page":"603","article-title":"Intrathecal baclofen for intractable cerebral spasticity: a prospective placebo-controlled, double-blind study","volume":"46","author":"Van Schaeybroeck P","year":"2000","unstructured":"Van Schaeybroeck P, Nuttin B, Lagae L, Schrijvers E, Borghgraef C, Feys P. Intrathecal baclofen for intractable cerebral spasticity: a prospective placebo-controlled, double-blind study. Neurosurgery. 2000;46(3):603\u2013612."},{"issue":"2","key":"b7","series-title":"BJA Educ","first-page":"51","article-title":"Complications associated with intrathecal drug delivery systems","volume":"20","author":"Delhaas EM","year":"2020","unstructured":"Delhaas EM, Huygen FJPM. Complications associated with intrathecal drug delivery systems. BJA Educ. 2020;20(2):51\u201357."},{"issue":"3","key":"b8","series-title":"Neuromodulation","first-page":"266","article-title":"Rate of complications among the recipients of intrathecal baclofen pump in Japan: a multicenter study","volume":"16","author":"Taira T","year":"2013","unstructured":"Taira T, Ueta T, Katayama Y, Rate of complications among the recipients of intrathecal baclofen pump in Japan: a multicenter study. Neuromodulation. 2013;16(3):266\u2013272."},{"key":"b9","series-title":"Mult Scler Relat Disord","first-page":"95","article-title":"Intrathecal baclofen for multiple sclerosis related spasticity: a twenty year experience","volume":"27","author":"Sammaraiee Y","year":"2019","unstructured":"Sammaraiee Y, Yardley M, Keenan L, Buchanan K, Stevenson V, Farrell R. Intrathecal baclofen for multiple sclerosis related spasticity: a twenty year experience. Mult Scler Relat Disord. 2019;27:95-100."},{"issue":"4","key":"b10","series-title":"Clin Neurol Neurosurg","first-page":"321","article-title":"Intrathecal baclofen therapy for severe spasticity: analysis on a series of 112 consecutive patients and future prospectives","volume":"114","author":"Natale M","year":"2012","unstructured":"Natale M, Mirone G, Rotondo M, Moraci A. Intrathecal baclofen therapy for severe spasticity: analysis on a series of 112 consecutive patients and future prospectives. Clin Neurol Neurosurg. 2012;114(4):321\u2013325."},{"key":"b11","series-title":"World Neurosurg","first-page":"e59","article-title":"Infectious complications and operative management of intrathecal baclofen pumps in the pediatric population: a systematic review and meta-analysis of 20 years of pooled experience","volume":"163","author":"Nuru M","year":"2022","unstructured":"Nuru M, Maglinger B, Vessell M, Infectious complications and operative management of intrathecal baclofen pumps in the pediatric population: a systematic review and meta-analysis of 20 years of pooled experience. World Neurosurg. 2022;163:e59\u2013e72."},{"issue":"4","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"493","article-title":"Comparison between an Ascenda and a silicone catheter in intrathecal baclofen therapy in pediatric patients: analysis of complications","volume":"18","author":"Motta F","year":"2016","unstructured":"Motta F, Antonello CE. Comparison between an Ascenda and a silicone catheter in intrathecal baclofen therapy in pediatric patients: analysis of complications. J Neurosurg Pediatr. 2016;18(4):493\u2013498."},{"issue":"5","key":"b13","series-title":"Brain Behav","first-page":"e00965","article-title":"Eleven years\u2019 experience with intrathecal baclofen\u2014complications, risk factors","volume":"8","author":"Pucks-Faes E","year":"2018","unstructured":"Pucks-Faes E, Hitzenberger G, Matzak H, Eleven years\u2019 experience with intrathecal baclofen\u2014complications, risk factors. Brain Behav. 2018;8(5):e00965."},{"issue":"5","key":"b14","series-title":"J Neurosurg Pediatr","first-page":"487","article-title":"Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors","volume":"4","author":"Fjelstad AB","year":"2009","unstructured":"Fjelstad AB, Hommelstad J, Sorteberg A. Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors. J Neurosurg Pediatr. 2009;4(5):487\u2013493."},{"issue":"6","key":"b15","series-title":"J Neurosurg Pediatr","first-page":"756","article-title":"Risk factors for baclofen pump infection in children: a multivariate analysis","volume":"17","author":"Spader HS","year":"2016","unstructured":"Spader HS, Bollo RJ, Bowers CA, Riva-Cambrin J. Risk factors for baclofen pump infection in children: a multivariate analysis. J Neurosurg Pediatr. 2016;17(6):756\u2013762."},{"issue":"12","key":"b16","series-title":"Arch Phys Med Rehabil","first-page":"1721","article-title":"Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications","volume":"83","author":"Murphy NA","year":"2002","unstructured":"Murphy NA, Irwin MC, Hoff C. Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications. Arch Phys Med Rehabil. 2002;83(12):1721\u20131725."},{"key":"b17","series-title":"Eur J Paediatr Neurol","first-page":"94","article-title":"Surgical complications of intrathecal baclofen in children: a single centre, 20-year retrospective cohort study","volume":"37","author":"Bonouvri\u00e9 LA","year":"2022","unstructured":"Bonouvri\u00e9 LA, Lagendijk KE, Beckerman H, Slot KM, van de Pol LA, Buizer AI. Surgical complications of intrathecal baclofen in children: a single centre, 20-year retrospective cohort study. Eur J Paediatr Neurol. 2022;37:94\u201397."},{"issue":"6","key":"b18","series-title":"J Pediatr Orthop","first-page":"e522","article-title":"Evaluation of risk factors for cerebrospinal leakage in pediatric patients with cerebral palsy treated with intrathecal baclofen","volume":"40","author":"Imerci A","year":"2020","unstructured":"Imerci A, Rogers KJ, Miller F, Sees JP. Evaluation of risk factors for cerebrospinal leakage in pediatric patients with cerebral palsy treated with intrathecal baclofen. J Pediatr Orthop. 2020;40(6):e522\u2013e526."},{"key":"b19","series-title":"World Neurosurg","first-page":"e456","article-title":"Intrathecal baclofen and opioid therapy: cerebrospinal fluid leak and infection incidence, risk factors, and outcomes","volume":"171","author":"Wilson C","year":"2023","unstructured":"Wilson C, Linczer J, Newman S, Intrathecal baclofen and opioid therapy: cerebrospinal fluid leak and infection incidence, risk factors, and outcomes. World Neurosurg. 2023;171:e456\u2013e463."},{"key":"b20","series-title":"Clin Neurol Neurosurg","first-page":"106630","article-title":"Complications of intrathecal drug delivery therapy (ITDD): a retrospective study of 231 implantations between 1999 and 2014","volume":"205","author":"Necking E","year":"2021","unstructured":"Necking E, Levi R, Ertzgaard P. Complications of intrathecal drug delivery therapy (ITDD): a retrospective study of 231 implantations between 1999 and 2014. Clin Neurol Neurosurg. 2021;205:106630."},{"issue":"23","key":"b21","series-title":"Eur Heart J","first-page":"1862","article-title":"Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982-2018)","volume":"40","author":"Olsen T","year":"2019","unstructured":"Olsen T, J\u00f8rgensen OD, Nielsen JC, Th\u00f8gersen AM, Philbert BT, Johansen JB. Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982-2018). Eur Heart J. 2019;40(23):1862\u20131869."},{"issue":"3","key":"b22","series-title":"J Leukoc Biol","first-page":"525","article-title":"Obesity and type 2 diabetes mellitus drive immune dysfunction, infection development, and sepsis mortality","volume":"104","author":"Frydrych LM","year":"2018","unstructured":"Frydrych LM, Bian G, O\u2019Lone DE, Ward PA, Delano MJ. Obesity and type 2 diabetes mellitus drive immune dysfunction, infection development, and sepsis mortality. J Leukoc Biol. 2018;104(3):525\u2013534."},{"issue":"1","key":"b23","series-title":"Open Forum Infect Dis","first-page":"ofaa545","article-title":"The association between body mass index and the risk of hospitalization and mortality due to infection: a prospective cohort study","volume":"8","author":"Yang WS","year":"2020","unstructured":"Yang WS, Chang YC, Chang CH, Wu LC, Wang JL, Lin HH. The association between body mass index and the risk of hospitalization and mortality due to infection: a prospective cohort study. 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