{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:09:38Z","timestamp":1787612978763,"version":"build-2736575974"},"reference-count":44,"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 Intrathecal baclofen (ITB) is an effective treatment for hypertonia in children involving the implantation of a pump and catheter system. The highest concentration of ITB is at the catheter tip. The catheter tip location is most commonly within the lumbar or thoracic spine. The cervical tip location has traditionally been avoided because of concerns of hypoventilation and pneumonia; however, these complications in cervical compared with thoracic or lumbar placement have not been reliably proven. Some studies have suggested that cervical ITB location better treats upper-extremity hypertonia. There are limited data describing the safety and efficacy of cervical ITB on hypertonia. The authors present a single-institution retrospective case series highlighting the safety and efficacy of using cervical ITB location for the treatment of hypertonia.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Retrospective data analysis was performed for children who underwent continuous dosing cervical ITB between April 2022 and October 2023. Nonmodifiable risk factors, clinical variables, operative characteristics, and adverse outcomes were collected.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n This study included 25 patients (8 female). The mean age at implantation was 12.4 years, and the mean operative duration was 90 minutes. The mean Barry-Albright Dystonia Scale score decreased by 9.5 points (p = 0.01). The mean aggregated modified Ashworth scale score in the upper extremities decreased by 2.14 points (p = 0.04), and that in the lower extremities decreased by 4.98 points (p < 0.01). One patient each (4%) had infection and baclofen toxicity. Two patients (8%) had respiratory depression requiring continuous positive airway pressure. There was no incidence of pneumonia or wound dehiscence.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The cervical catheter tip location for ITB is safe, is effective to control tone, and should be considered for the treatment of hypertonia. Larger studies with longer follow-up are necessary to further determine upper-limit dosing safety along with long-term functional benefits in these patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.3.focus2475","type":"journal-article","created":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T05:42:37Z","timestamp":1717220557000},"page":"E13","source":"Crossref","is-referenced-by-count":4,"title":["Safety and efficacy of continuous intrathecal baclofen via cervical catheter tip: a retrospective case series"],"prefix":"10.3171","volume":"56","author":[{"given":"James","family":"Mossner","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois;"},{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunny","family":"Abdelmageed","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois;"},{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Votoupal","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Misasi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nour","family":"Saleh","sequence":"additional","affiliation":[{"name":"School of Medicine, New Giza University, Giza, Egypt; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaudia","family":"Dziugan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Krater","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Shirley Ryan AbilityLab, Chicago, Illinois"},{"name":"Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Raskin","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois;"},{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"7","key":"b1","series-title":"Curr Probl Pediatr Adolesc Health Care","first-page":"161","article-title":"Hypertonia","volume":"47","author":"Evans SH","year":"2017","unstructured":"Evans SH, Cameron MW, Burton JM. Hypertonia. Curr Probl Pediatr Adolesc Health Care. 2017;47(7):161\u2013166."},{"key":"b2","series-title":"Handb Clin Neurol","first-page":"497","article-title":"Treatment of spasticity","volume":"196","author":"Marsden J","year":"2023","unstructured":"Marsden J, Stevenson V, Jarrett L. Treatment of spasticity. Handb Clin Neurol. 2023;196:497\u2013521."},{"issue":"1","key":"b3","series-title":"Curr Opin Pediatr","first-page":"57","article-title":"Management of hypertonia in cerebral palsy","volume":"30","author":"Nahm NJ","year":"2018","unstructured":"Nahm NJ, Graham HK, Gormley ME Jr, Georgiadis AG. Management of hypertonia in cerebral palsy. Curr Opin Pediatr. 2018;30(1):57\u201364."},{"issue":"2","key":"b4","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Intrathecal baclofen therapy in children","volume":"21","author":"Albright AL","year":"2006","unstructured":"Albright AL, Ferson SS. Intrathecal baclofen therapy in children. Neurosurg Focus. 2006;21(2):E3."},{"issue":"8385","key":"b5","series-title":"Lancet","first-page":"1078","article-title":"Intrathecal baclofen alleviates spinal cord spasticity","volume":"1","author":"Penn RD","year":"1984","unstructured":"Penn RD, Kroin JS. Intrathecal baclofen alleviates spinal cord spasticity. Lancet. 1984;1(8385):1078."},{"issue":"3","key":"b6","series-title":"Neurosurgery","first-page":"634","article-title":"Cervical catheter tip placement for intrathecal baclofen administration","volume":"59","author":"McCall TD","year":"2006","unstructured":"McCall TD, MacDonald JD. Cervical catheter tip placement for intrathecal baclofen administration. Neurosurgery. 2006;59(3):634\u2013640."},{"issue":"8","key":"b7","series-title":"Spinal Cord","first-page":"413","article-title":"Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia","volume":"39","author":"Burns AS","year":"2001","unstructured":"Burns AS, Meythaler JM. Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia. Spinal Cord. 2001;39(8):413\u2013419."},{"issue":"10","key":"b8","series-title":"Dev Med Child Neurol","first-page":"660","article-title":"Long-term safety and efficacy of continuous intrathecal baclofen","volume":"44","author":"Campbell WM","year":"2002","unstructured":"Campbell WM, Ferrel A, McLaughlin JF, Long-term safety and efficacy of continuous intrathecal baclofen. Dev Med Child Neurol. 2002;44(10):660\u2013665."},{"issue":"2","key":"b9","series-title":"Neurosurgery","first-page":"226","article-title":"The distribution of medication along the spinal canal after chronic intrathecal administration","volume":"33","author":"Kroin JS","year":"1993","unstructured":"Kroin JS, Ali A, York M, Penn RD. The distribution of medication along the spinal canal after chronic intrathecal administration. Neurosurgery. 1993;33(2):226\u2013230."},{"issue":"7","key":"b10","series-title":"J Rehabil Med","first-page":"jrm00215","article-title":"Effectiveness and safety of cervical catheter tip placement in intrathecal baclofen treatment of spasticity: a systematic review","volume":"53","author":"Jacobs NW","year":"2021","unstructured":"Jacobs NW, Maas EM, Brusse-Keizer M, Rietman HJS. Effectiveness and safety of cervical catheter tip placement in intrathecal baclofen treatment of spasticity: a systematic review. J Rehabil Med. 2021;53(7):jrm00215."},{"issue":"10","key":"b11","series-title":"Dev Med Child Neurol","first-page":"1038","article-title":"Readmission and complications within 30 days after intrathecal baclofen pump placement","volume":"60","author":"Lam SK","year":"2018","unstructured":"Lam SK, Mayer RR, Vedantam A, Staggers KA, Harris DA, Pan IW. Readmission and complications within 30 days after intrathecal baclofen pump placement. Dev Med Child Neurol. 2018;60(10):1038\u20131044."},{"issue":"1 suppl","key":"b12","series-title":"Technical note. J Neurosurg","first-page":"119","article-title":"Posterior cervical approach for intrathecal baclofen pump insertion in children with previous spinal fusions","volume":"102","author":"Liu JK","year":"2005","unstructured":"Liu JK, Walker ML. Posterior cervical approach for intrathecal baclofen pump insertion in children with previous spinal fusions. Technical note. J Neurosurg. 2005;102(1 suppl):119\u2013122."},{"issue":"3","key":"b13","series-title":"J Rehabil Med","first-page":"193","article-title":"Efficacy and safety of oral baclofen in the management of spasticity: a rationale for intrathecal baclofen","volume":"49","author":"Ertzgaard P","year":"2017","unstructured":"Ertzgaard P, Campo C, Calabrese A. Efficacy and safety of oral baclofen in the management of spasticity: a rationale for intrathecal baclofen. J Rehabil Med. 2017;49(3):193\u2013203."},{"issue":"1","key":"b14","series-title":"J Child Neurol","first-page":"31","article-title":"Pharmacotherapy of spasticity: oral medications and intrathecal baclofen","volume":"16","author":"Krach LE","year":"2001","unstructured":"Krach LE. Pharmacotherapy of spasticity: oral medications and intrathecal baclofen. J Child Neurol. 2001;16(1):31\u201336."},{"issue":"4","key":"b15","series-title":"Arch Phys Med Rehabil","first-page":"604","article-title":"Effectiveness of oral baclofen in the treatment of spasticity in children and adolescents with cerebral palsy","volume":"97","author":"Navarrete-Opazo AA","year":"2016","unstructured":"Navarrete-Opazo AA, Gonzalez W, Nahuelhual P. Effectiveness of oral baclofen in the treatment of spasticity in children and adolescents with cerebral palsy. Arch Phys Med Rehabil. 2016;97(4):604\u2013618."},{"issue":"8462","key":"b16","series-title":"Lancet","first-page":"1003","article-title":"Intrathecal baclofen for spasticity","volume":"2","author":"Dralle D","year":"1985","unstructured":"Dralle D, M\u00fcller H, Zierski J, Klug N. Intrathecal baclofen for spasticity. Lancet. 1985;2(8462):1003."},{"issue":"34","key":"b17","series-title":"Medicine (Baltimore)","first-page":"e7472","article-title":"Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury","volume":"96","author":"Yoon YK","year":"2017","unstructured":"Yoon YK, Lee KC, Cho HE, Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury. Medicine (Baltimore). 2017;96(34):e7472."},{"issue":"9","key":"b18","series-title":"Childs Nerv Syst","first-page":"971","article-title":"Intrathecal baclofen for childhood hypertonia","volume":"23","author":"Albright AL","year":"2007","unstructured":"Albright AL. Intrathecal baclofen for childhood hypertonia. Childs Nerv Syst. 2007;23(9):971\u2013979."},{"issue":"20","key":"b19","series-title":"JAMA","first-page":"2475","article-title":"Continuous intrathecal baclofen infusion for spasticity of cerebral origin","volume":"270","author":"Albright AL","year":"1993","unstructured":"Albright AL, Barron WB, Fasick MP, Polinko P, Janosky J. Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA. 1993;270(20):2475\u20132477."},{"issue":"1","key":"b20","series-title":"Clinical article. J Neurosurg Pediatr","first-page":"11","article-title":"Intraventricular baclofen for dystonia: techniques and outcomes","volume":"3","author":"Albright AL","year":"2009","unstructured":"Albright AL, Ferson SS. Intraventricular baclofen for dystonia: techniques and outcomes. Clinical article. J Neurosurg Pediatr. 2009;3(1):11\u201314."},{"issue":"6","key":"b21","series-title":"Dev Med Child Neurol","first-page":"404","article-title":"Reliability and responsiveness of the Barry-Albright Dystonia Scale","volume":"41","author":"Barry MJ","year":"1999","unstructured":"Barry MJ, VanSwearingen JM, Albright AL. Reliability and responsiveness of the Barry-Albright Dystonia Scale. Dev Med Child Neurol. 1999;41(6):404\u2013411."},{"issue":"2","key":"b22","series-title":"Phys Ther","first-page":"206","article-title":"Interrater reliability of a modified Ashworth scale of muscle spasticity","volume":"67","author":"Bohannon RW","year":"1987","unstructured":"Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206\u2013207."},{"issue":"7","key":"b1","series-title":"Curr Probl Pediatr Adolesc Health Care","first-page":"161","article-title":"Hypertonia","volume":"47","author":"Evans SH","year":"2017","unstructured":"Evans SH, Cameron MW, Burton JM. Hypertonia. Curr Probl Pediatr Adolesc Health Care. 2017;47(7):161\u2013166."},{"key":"b2","series-title":"Handb Clin Neurol","first-page":"497","article-title":"Treatment of spasticity","volume":"196","author":"Marsden J","year":"2023","unstructured":"Marsden J, Stevenson V, Jarrett L. Treatment of spasticity. Handb Clin Neurol. 2023;196:497\u2013521."},{"issue":"1","key":"b3","series-title":"Curr Opin Pediatr","first-page":"57","article-title":"Management of hypertonia in cerebral palsy","volume":"30","author":"Nahm NJ","year":"2018","unstructured":"Nahm NJ, Graham HK, Gormley ME Jr, Georgiadis AG. Management of hypertonia in cerebral palsy. Curr Opin Pediatr. 2018;30(1):57\u201364."},{"issue":"2","key":"b4","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Intrathecal baclofen therapy in children","volume":"21","author":"Albright AL","year":"2006","unstructured":"Albright AL, Ferson SS. Intrathecal baclofen therapy in children. Neurosurg Focus. 2006;21(2):E3."},{"issue":"8385","key":"b5","series-title":"Lancet","first-page":"1078","article-title":"Intrathecal baclofen alleviates spinal cord spasticity","volume":"1","author":"Penn RD","year":"1984","unstructured":"Penn RD, Kroin JS. Intrathecal baclofen alleviates spinal cord spasticity. Lancet. 1984;1(8385):1078."},{"issue":"3","key":"b6","series-title":"Neurosurgery","first-page":"634","article-title":"Cervical catheter tip placement for intrathecal baclofen administration","volume":"59","author":"McCall TD","year":"2006","unstructured":"McCall TD, MacDonald JD. Cervical catheter tip placement for intrathecal baclofen administration. Neurosurgery. 2006;59(3):634\u2013640."},{"issue":"8","key":"b7","series-title":"Spinal Cord","first-page":"413","article-title":"Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia","volume":"39","author":"Burns AS","year":"2001","unstructured":"Burns AS, Meythaler JM. Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia. Spinal Cord. 2001;39(8):413\u2013419."},{"issue":"10","key":"b8","series-title":"Dev Med Child Neurol","first-page":"660","article-title":"Long-term safety and efficacy of continuous intrathecal baclofen","volume":"44","author":"Campbell WM","year":"2002","unstructured":"Campbell WM, Ferrel A, McLaughlin JF, Long-term safety and efficacy of continuous intrathecal baclofen. Dev Med Child Neurol. 2002;44(10):660\u2013665."},{"issue":"2","key":"b9","series-title":"Neurosurgery","first-page":"226","article-title":"The distribution of medication along the spinal canal after chronic intrathecal administration","volume":"33","author":"Kroin JS","year":"1993","unstructured":"Kroin JS, Ali A, York M, Penn RD. The distribution of medication along the spinal canal after chronic intrathecal administration. Neurosurgery. 1993;33(2):226\u2013230."},{"issue":"7","key":"b10","series-title":"J Rehabil Med","first-page":"jrm00215","article-title":"Effectiveness and safety of cervical catheter tip placement in intrathecal baclofen treatment of spasticity: a systematic review","volume":"53","author":"Jacobs NW","year":"2021","unstructured":"Jacobs NW, Maas EM, Brusse-Keizer M, Rietman HJS. Effectiveness and safety of cervical catheter tip placement in intrathecal baclofen treatment of spasticity: a systematic review. J Rehabil Med. 2021;53(7):jrm00215."},{"issue":"10","key":"b11","series-title":"Dev Med Child Neurol","first-page":"1038","article-title":"Readmission and complications within 30 days after intrathecal baclofen pump placement","volume":"60","author":"Lam SK","year":"2018","unstructured":"Lam SK, Mayer RR, Vedantam A, Staggers KA, Harris DA, Pan IW. Readmission and complications within 30 days after intrathecal baclofen pump placement. Dev Med Child Neurol. 2018;60(10):1038\u20131044."},{"issue":"1 suppl","key":"b12","series-title":"Technical note. J Neurosurg","first-page":"119","article-title":"Posterior cervical approach for intrathecal baclofen pump insertion in children with previous spinal fusions","volume":"102","author":"Liu JK","year":"2005","unstructured":"Liu JK, Walker ML. Posterior cervical approach for intrathecal baclofen pump insertion in children with previous spinal fusions. Technical note. J Neurosurg. 2005;102(1 suppl):119\u2013122."},{"issue":"3","key":"b13","series-title":"J Rehabil Med","first-page":"193","article-title":"Efficacy and safety of oral baclofen in the management of spasticity: a rationale for intrathecal baclofen","volume":"49","author":"Ertzgaard P","year":"2017","unstructured":"Ertzgaard P, Campo C, Calabrese A. Efficacy and safety of oral baclofen in the management of spasticity: a rationale for intrathecal baclofen. J Rehabil Med. 2017;49(3):193\u2013203."},{"issue":"1","key":"b14","series-title":"J Child Neurol","first-page":"31","article-title":"Pharmacotherapy of spasticity: oral medications and intrathecal baclofen","volume":"16","author":"Krach LE","year":"2001","unstructured":"Krach LE. Pharmacotherapy of spasticity: oral medications and intrathecal baclofen. J Child Neurol. 2001;16(1):31\u201336."},{"issue":"4","key":"b15","series-title":"Arch Phys Med Rehabil","first-page":"604","article-title":"Effectiveness of oral baclofen in the treatment of spasticity in children and adolescents with cerebral palsy","volume":"97","author":"Navarrete-Opazo AA","year":"2016","unstructured":"Navarrete-Opazo AA, Gonzalez W, Nahuelhual P. Effectiveness of oral baclofen in the treatment of spasticity in children and adolescents with cerebral palsy. Arch Phys Med Rehabil. 2016;97(4):604\u2013618."},{"issue":"8462","key":"b16","series-title":"Lancet","first-page":"1003","article-title":"Intrathecal baclofen for spasticity","volume":"2","author":"Dralle D","year":"1985","unstructured":"Dralle D, M\u00fcller H, Zierski J, Klug N. Intrathecal baclofen for spasticity. Lancet. 1985;2(8462):1003."},{"issue":"34","key":"b17","series-title":"Medicine (Baltimore)","first-page":"e7472","article-title":"Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury","volume":"96","author":"Yoon YK","year":"2017","unstructured":"Yoon YK, Lee KC, Cho HE, Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury. Medicine (Baltimore). 2017;96(34):e7472."},{"issue":"9","key":"b18","series-title":"Childs Nerv Syst","first-page":"971","article-title":"Intrathecal baclofen for childhood hypertonia","volume":"23","author":"Albright AL","year":"2007","unstructured":"Albright AL. Intrathecal baclofen for childhood hypertonia. Childs Nerv Syst. 2007;23(9):971\u2013979."},{"issue":"20","key":"b19","series-title":"JAMA","first-page":"2475","article-title":"Continuous intrathecal baclofen infusion for spasticity of cerebral origin","volume":"270","author":"Albright AL","year":"1993","unstructured":"Albright AL, Barron WB, Fasick MP, Polinko P, Janosky J. Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA. 1993;270(20):2475\u20132477."},{"issue":"1","key":"b20","series-title":"Clinical article. J Neurosurg Pediatr","first-page":"11","article-title":"Intraventricular baclofen for dystonia: techniques and outcomes","volume":"3","author":"Albright AL","year":"2009","unstructured":"Albright AL, Ferson SS. Intraventricular baclofen for dystonia: techniques and outcomes. Clinical article. J Neurosurg Pediatr. 2009;3(1):11\u201314."},{"issue":"6","key":"b21","series-title":"Dev Med Child Neurol","first-page":"404","article-title":"Reliability and responsiveness of the Barry-Albright Dystonia Scale","volume":"41","author":"Barry MJ","year":"1999","unstructured":"Barry MJ, VanSwearingen JM, Albright AL. Reliability and responsiveness of the Barry-Albright Dystonia Scale. Dev Med Child Neurol. 1999;41(6):404\u2013411."},{"issue":"2","key":"b22","series-title":"Phys Ther","first-page":"206","article-title":"Interrater reliability of a modified Ashworth scale of muscle spasticity","volume":"67","author":"Bohannon RW","year":"1987","unstructured":"Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206\u2013207."}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/56\/6\/article-pE13.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/56\/6\/article-pE13.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/56\/6\/article-pE13.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:50:54Z","timestamp":1780131054000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/56\/6\/article-pE13.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6]]},"references-count":44,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2024.3.focus2475","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6]]}}}