Functional and Surgical Outcomes of Intrathecal Baclofen Therapy: A Retrospective Study at a Tertiary Neurosurgical Centre in Upper Egypt (2022–2024)

Abstract

Background: Intrathecal baclofen (ITB) pump therapy is a well-established intervention for refractory spasticity. Its effectiveness depends not only on pharmacological action but also on surgical precision and multidisciplinary care. Methodology: We retrospectively reviewed 15 adult patients (mean age 45.3 ± 11.9 years) with refractory spasticity due to multiple sclerosis (9/15, 60%), cerebral palsy (2/15, 13.3%), hereditary spastic paraparesis (2/15, 13.3%), spinocerebellar degeneration (1/15, 6.7%), and stroke (1/15, 6.7%). Inclusion criteria: age ≥18 years, central spasticity unresponsive to oral medications and physiotherapy, significant functional impairment, and positive ITB test dose. Exclusion criteria: age <18 years, severe fixed contractures, uncontrolled infection, progressive systemic illness precluding surgery, or negative test trial. Functional outcomes were assessed at baseline, 6 months, and 12 months using the Modified Ashworth Scale (MAS), Penn Spasm Scale (PSS), Numeric Pain Scale (NPS), and Gross Motor Function Classification System (GMFCS). Surgical details and complications were also recorded. Results: Spasticity and pain improved significantly and consistently across measures. The Modified Ashworth Scale (MAS) decreased from 2.9 ± 0.9 to 1.1 ± 0.6 at 12 months, indicating a mean reduction of 1.8 points (95% CI, 1.2 - 2.4; p < 0.001). Spasm frequency (PSS) declined by 1.6 points (95% CI, 1.0–2.1; p < 0.001), and pain intensity (NPS) fell by 4.3 points (95% CI, 3.4–5.2; p < 0.001). Nearly half of the cohort (47%) achieved an improvement of at least one GMFCS level, and 67% surpassed their preoperative functional goals on Goal Attainment Scaling (GAS). Regression analysis revealed that a younger age (β = –0.03, 95% CI –0.05 to –0.01; p = 0.006) and a shorter disease duration (β = –0.02, 95% CI –0.04 to –0.001; p = 0.041) are significant predictors of increased tone reduction. Complications occurred in 27% of patients, predominantly catheter-related, with no systemic adverse events. Conclusion: ITB pump implantation delivers sustained reduction in spasticity, spasms, and pain, alongside meaningful functional gains in mobility and caregiving ease. Surgical techniques—particularly pump pocket creation, catheter stabilisation, and wound closure—were shown to be critical in minimising complications and preserving long-term efficacy. Beyond scale-based improvements, patients experienced enhanced comfort, improved sleep, and reduced caregiver burden.