Adult Scoliosis Following Intrathecal Baclofen Therapy

January 11, 2022

Case Reports

. 2022 Jan 4;14(1):e20937.

doi: 10.7759/cureus.20937.

eCollection 2022 Jan.

Affiliations

¹ Department of Neurosurgery, Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Fukuoka, JPN.
² Department of Neurosurgery, Himeno Hospital, Fukuoka, JPN.
³ Neuroanesthesia Research Laboratory, Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Fukuoka, JPN.
⁴ Department of Neurosurgery, Fukuoka Mirai Hospital, Fukuoka, JPN.

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Case Reports

Hiroshi Fujioka et al.

Cureus.

2022.

. 2022 Jan 4;14(1):e20937.

doi: 10.7759/cureus.20937.

eCollection 2022 Jan.

Affiliations

¹ Department of Neurosurgery, Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Fukuoka, JPN.
² Department of Neurosurgery, Himeno Hospital, Fukuoka, JPN.
³ Neuroanesthesia Research Laboratory, Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Fukuoka, JPN.
⁴ Department of Neurosurgery, Fukuoka Mirai Hospital, Fukuoka, JPN.

Item in Clipboard

Abstract

In this case report, we present an adult case of scoliosis following intrathecal baclofen (ITB) therapy. A 56-year-old female with stroke-induced right spastic hemiparesis for seven years underwent implantation of an ITB pump. Satisfactory spasticity control was achieved using 30 µg/day of baclofen; however, she began to complain of lumbar pain in the postoperative year (POY) 1. Scoliosis, which was not recognized preoperatively, was confirmed in POY 2 (Cobb angle of 19 degrees). It further progressed into a walking disturbance in POY 5 (Cobb angle of 28 degrees). Hence, posterior fusion with decompression was planned. Following the removal of the ITB pump, spasticity management was replaced by Botox injection. However, the progression of scoliosis and neurological conditions stabilized after the removal, and decompression surgery was electively performed in POY 6. Scoliosis remained stable during the two-year follow-up period (Cobb angle of 28 degrees). This case demonstrates the potential risk of ITB-induced scoliosis in an adult patient. Careful preoperative investigations and postoperative follow-up are recommended for patients on ITB therapy.

Keywords:

adult; iatrogenic; intrathecal baclofen; scoliosis; spasticity.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

**Figure 1. Preoperative head CT.**

Plain head CT showed old vascular lesions over the left hemisphere, which were associated with right spastic paresis. CT: computed tomography

**Figure 2. X-rays before and after ITB therapy.**

Compared to the X-ray performed in POY zero, scoliosis was evident in POY two. Following the removal of the ITB pump in POY five, decompression surgery was electively performed in POY six. Thereafter, the progression of scoliosis ceased for two years and Cobb angle remained at 28 degrees. The rectangular object in the left abdomen is an implantable pulse generator for motor cortex stimulation. ITB: intrathecal baclofen; POY: postoperative year

**Figure 3. 3D-CT after decompression surgery.**

Decompression was performed at the left L3/4 and L5/6 vertebral levels. 3D-CT: three-dimensional computed tomography

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