An intrathecal baclofen pump is a device for treatment of severe spasticity. This medical device is placed under the skin during a surgery (generally under abdominal skin) and is used to deliver baclofen directly into the intrathecal space surrounding the spinal cord. Baclofen stimulates GABA-B receptros and acts as a skeletal muscle relaxant.
Implantation of a Sacral Anterior Root Stimulator (Brindley et al. 1982) for bladder control usually entails rhizotomy of posterior sacral roots to improve bladder capacity and compliance and reduce reflex incontinence and possibly sphincter spasticity, but in so doing has the disadvantage in men with SCI of abolishing reflex erection, and ejaculation when present. While not the primary indication for implantation, continuous stimulation of S2 or S3 anterior roots has been shown to achieve a sustained and full erection in all of a series of 14 men with complete SCI lesions between C5 –T10 level (van der Aa et al. 1995). Vignes et al. (2001) reported that 60 percent of men with complete SCI were able to achieve an erection by continuous stimulation of S2 roots.
In addition, concerns have been raised about the impact of intrathecal baclofen (a drug to control spasticity) on sexual function among men with SCI. Baclofen may have an effect on sexual function presumably secondary to the inhibition of visceral afferent input to the lumbosacral spinal cord (Steers et al. 1992). Jones et al. (2008) reported that although there was minimal impact on sexual function after baclofen pump implantation, there was a possible dose response between baclofen and sexual function (ie, higher the dose to control spasticity, poorer the erection function). Four out of seven subjects noted a decrease in perceived sexual function following an increase in baclofen dosages, although some were utilizing PDE5i as well, and one subject reported a dramatic improvement in rating of sexual function with increase and later tapering in baclofen dose. Denys et al. (1998) reported similar inconsistent findings leading the authors to conclude that the effects of baclofen on sexual function seem to be transitory and reversible with withdrawal or reduction in dose.
There is level 4 evidence (Denys et al. 1998; Jones et al. 2008) that implantation of intrathecal baclofen pump, while effective in managing spasticity, may cause difficulties with erection and sexual function.
- Implantation of an intrathecal baclofen pump, while effective in managing spasticity, may cause difficulties with erection and sexual function.