Programmable pumps can be surgically implanted for the treatment of spasticity in SCI. The most commonly delivered drug is intrathecal baclofen (ITB). Many of the studies looking at intrathecal baclofen use for spasticity combine multiple causes of spasticity (SCI, multiple sclerosis and cerebral palsy) which makes the results difficult to interpret for SCI specifically. Several of the studies in this section include studies where fewer than 50% of the patients have SCI. While these individual studies may not meet the formal SCIRE criteria, their importance for inclusion emerged by representing a larger number of patients with spinal cord injuries when grouped together.
Outcome measures for intrathecal baclofen include direct spasticity measures such as the Ashworth and MAS and spasm frequency scales, and indirect measures such as functional outcome measures, complication rates and quality of life as well as cost-benefit analyses.
While oral baclofen can be useful in the treatment of spasticity, the use of high doses can lead to adverse effects, most commonly over sedation. Delivering baclofen directly into the cerebral spinal fluid allows a higher concentration of baclofen administration to the spinal cord with fewer systemic side effects. ITB is most effective in treating lower extremity spasticity and less so for upper extremity spasticity. However, the location of the intrathecal catheter tip can be adjusted at the time of surgical implantation depending on the clinical presentation with higher tip locations (cephalad at T6, compared to T10-L2) being used in patients with higher injuries (Burns & Meythaler 2001). The pump can be programmed to provide a steady dose of intrathecal baclofen throughout the day or programmed to include boluses at certain times of the day. ITB is usually only considered after one year post-SCI.
Potential complications from intrathecal baclofen treatment include overdose, withdrawal and surgical complications. Disruption or malfunction of the catheter-pump system is a common cause of withdrawal and can result in an acute life-threatening baclofen withdrawal syndrome. The signs and symptoms of acute intrathecal baclofen withdrawal include increased spasticity, itching, fever, altered mental status, rhaobdomyolysis, seizures, reversible cardiomyopathy, and death.