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Ann Rehabil Med > Volume 47(1); 2023 > Article
Cho: Intrathecal Baclofen Therapy: Pros and Cons
Intrathecal baclofen (ITB) therapy is known to directly control spasticity in the spinal cord with fewer systemic adverse effects in a variety of neurological diseases including spinal cord injury, cerebral palsy (CP), stroke, traumatic brain injury, and hypoxic brain injury [1-4]. ITB therapy can effectively reduce severe spasticity that does not respond to oral medications or botulinum toxin treatment [5,6]. In addition, ITB therapy is reversible and continuously controls spasticity, whereas orthopedic musculoskeletal surgery and selective posterior rhizotomy are irreversible [7,8].
Previous experience with ITB screening tests (Table 1) showed beneficial effects such as spasticity reduction, improved sitting posture and sleep pattern, and decreased excessive sweating and chronic pain [8]. However, it can cause adverse effects, such as headache, dizziness, drowsiness, nausea, vomiting, dysarthria, posterior neck pain, voiding difficulty, and respiratory depression, aside from surgical or catheter-related complications [9-13].
In other issues, spasticity reduction not only induces functional improvement but also causes functional impairments due to muscle hypotonia and instability in walking and standing [9]. I actually experienced that ambulatory patients with CP showed standing impairment or gait disturbance after ITB bolus injection [8]. Therefore, confirming functional changes via ITB test trials is necessary to reduce spasticity without functional impairments before ITB pump implantation [8,14].
I also experienced reversible adverse effects, such as headache, drowsiness, and decreased sitting balance after ITB pump implantation, in which symptoms were relieved after adjusting the infusion dose and maintaining an appropriate dose to maximize the beneficial effects while minimizing the negative events [8,15]. Recent studies have suggested that early exposure to ITB therapy is appropriate to prevent musculoskeletal deformities and contracture [16] and participate in active rehabilitation programs [17] in contrast to the conventional concept that ITB pump implantation should be delayed for over 1 year post-onset. Patients with severe spasticity should consider early application of ITB therapy to decrease caregiver burden, prevent complications, and eventually improve function.
However, the impact on scoliosis after ITB pump implantation has been controversial in children with CP with further scoliosis progression [18-20] vs. no significant difference [21,22]. In their study published in current issue of Annals of Rehabilitation Medicine, Lee et al. [23] performed a systematic review and meta-analysis which showed that ITB pump implantation accelerates annual Cobb’s angle progression in children with CP. Patients with ITB pump implantation showed a faster rate of scoliosis progression probably due to paraspinal muscle hypotonia, although patients with no ITB pump implantation also showed aggravation of scoliosis. Severe scoliosis might negatively affect sitting or standing posture and activities of daily living, causing caregiver burden [24-26].
Nonetheless, spinal curvature can be managed using an inner seat system because scoliosis progression is not an unpredictable phenomenon when ITB therapy reduces paraspinal muscle spasticity and hypertonia. In contrast, ITB therapy may decrease hip adductor spasticity, pelvic obliquity, and hip subluxation or dislocation, presumably alleviating scoliosis acceleration and perineal care burden. Therefore, the results of this meta-analysis should be carefully interpreted, and advantages and disadvantages of ITB therapy should be carefully considered before ITB pump implantation.


Sung-Rae Cho is a Section Editor of Annals of Rehabilitation Medicine. The author did not engage in any part of the review and decision-making process for this manuscript. Otherwise, no potential conflict of interest relevant to this article was reported.


This study was supported by the Korean Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) (HI21C1314, HI22C1588), and the Korean Fund for Regenerative Medicine (KFRM) grant (21A0202L1, 21C0715L1).

Table 1.
Outcomes of the intrathecal baclofen therapy screening tests
Positive effects Negative effects
Decreased spasticity Muscle hypotonia
Decreased dystonic movement Standing or gait disturbance
Decreased chronic pain Headache, posterior neck pain
Decreased excessive sweating Dizziness, drowsiness
Improved sitting posture Nausea, vomiting
Improved sleep pattern Voiding difficulty
Improved dysarthria Dysarthria
Respiratory depression


1. Penn RD, Kroin JS. Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1984;1:1078.
crossref pmid
2. Penn RD, Kroin JS. Continuous intrathecal baclofen for severe spasticity. Lancet 1985;2:125-7.
crossref pmid
3. Ethans K. Intrathecal baclofen therapy: indications, pharmacology, surgical implant, and efficacy. Acta Neurochir Suppl 2007;97(Pt 1): 155-62.
4. Brennan PM, Whittle IR. Intrathecal baclofen therapy for neurological disorders: a sound knowledge base but many challenges remain. Br J Neurosurg 2008;22:508-19.
crossref pmid
5. Van Schaeybroeck P, Nuttin B, Lagae L, Schrijvers E, Borghgraef C, Feys P. Intrathecal baclofen for intractable cerebral spasticity: a prospective placebo-controlled, double-blind study. Neurosurgery 2000;46:603-9. discussion 609-12.
crossref pmid
6. Ueta T. [Intrathecal baclofen for severe spasticity]. Brain Nerve 2008;60:1415-20. Japanese.
7. Kan P, Gooch J, Amini A, Ploeger D, Grams B, Oberg W, et al. Surgical treatment of spasticity in children: comparison of selective dorsal rhizotomy and intrathecal baclofen pump implantation. Childs Nerv Syst 2008;24:239-43.
crossref pmid pdf
8. Yoon YK, Lee KC, Cho HE, Chae M, Chang JW, Chang WS, et al. Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury. Medicine (Baltimore) 2017;96:e7472.
crossref pmid pmc
9. Motta F, Buonaguro V, Stignani C. The use of intrathecal baclofen pump implants in children and adolescents: safety and complications in 200 consecutive cases. J Neurosurg 2007;107(1 Suppl): 32-5.
crossref pmid
10. Borowski A, Littleton AG, Borkhuu B, Presedo A, Shah S, Dabney KW, et al. Complications of intrathecal baclofen pump therapy in pediatric patients. J Pediatr Orthop 2010;30:76-81.
crossref pmid
11. Awaad Y, Rizk T, Siddiqui I, Roosen N, McIntosh K, Waines GM. Complications of intrathecal baclofen pump: prevention and cure. ISRN Neurol 2012;2012:575168.
crossref pmid pmc pdf
12. Sgouros S, Charalambides C, Matsota P, Tsangaris I, Kostopanagiotou G. Malfunction of SynchroMed II baclofen pump delivers a near-lethal baclofen overdose. Pediatr Neurosurg 2010;46:62-5.
crossref pmid pdf
13. Vidal J, Fenollosa P, Martin E, Barberá J, Robaina FJ, Fuentes M, et al. Safety and efficacy of intrathecal baclofen infusion by implantable pump for the treatment of severe spinal spasticity: a spanish multicenter study. Neuromodulation 2000;3:175-82.
crossref pmid
14. Phillips MM, Miljkovic N, Ramos-Lamboy M, Moossy JJ, Horton J, Buhari AM, et al. Clinical experience with continuous intrathecal baclofen trials prior to pump implantation. PM R 2015;7:1052-8.
crossref pmid pdf
15. Ordia JI, Fischer E, Adamski E, Spatz EL. Continuous intrathecal baclofen infusion delivered by a programmable pump for the treatment of severe spasticity following traumatic brain injury. Neuromodulation 2002;5:103-7.
crossref pmid
16. Saulino M, Ivanhoe CB, McGuire JR, Ridley B, Shilt JS, Boster AL. Best practices for intrathecal baclofen therapy: patient selection. Neuromodulation 2016;19:607-15.
crossref pmid
17. Maneyapanda MB, McCormick ZL, Marciniak C, Reger C. Long-term dosing of intrathecal baclofen in the treatment of spasticity after acquired brain injury. PM R 2017;9:556-62.
crossref pmid pdf
18. Sansone JM, Mann D, Noonan K, Mcleish D, Ward M, Iskandar BJ. Rapid progression of scoliosis following insertion of intrathecal baclofen pump. J Pediatr Orthop 2006;26:125-8.
crossref pmid
19. Lins LAB, Nechyporenko AV, Halanski MA, Hetzel SJ, Noonan KJ. Does an intrathecal baclofen pump impact scoliosis progression and complicate posterior spine fusion in patients with cerebral palsy? Spine Deform 2020;8:115-21.
crossref pmid pdf
20. Walker KR, Novotny SA, Krach LE. Does intrathecal baclofen therapy increase prevalence and/or progression of neuromuscular scoliosis? Spine Deform 2017;5:424-9.
crossref pmid
21. Rushton PRP, Nasto LA, Aujla RK, Ammar A, Grevitt MP, Vloeberghs MH. Intrathecal baclofen pumps do not accelerate progression of scoliosis in quadriplegic spastic cerebral palsy. Eur Spine J 2017;26:1652-7.
crossref pmid pdf
22. Shilt JS, Lai LP, Cabrera MN, Frino J, Smith BP. The impact of intrathecal baclofen on the natural history of scoliosis in cerebral palsy. J Pediatr Orthop 2008;28:684-7.
crossref pmid
23. Lee S, Hyun C, Kim K, Kwon HE, Woo M, Koh SE. Effect of intrathecal baclofen pump on scoliosis in children with cerebral palsy: a meta-analysis. Ann Rehabil Med 2023;doi: 10.5535/arm.22108 [Epub ahead of print].
24. Burn SC, Zeller R, Drake JM. Do baclofen pumps influence the development of scoliosis in children? J Neurosurg Pediatr 2010;5:195-9.
crossref pmid
25. Lee BK. Influence of the proprioceptive neuromuscular facilitation exercise programs on idiopathic scoliosis patient in the early 20s in terms of curves and balancing abilities: single case study. J Exerc Rehabil 2016;12:567-74.
crossref pmid pmc pdf
26. Willson LR, Rogers LG, Gingrich N, Shearer K, Hryniuk SS. Meeting the needs of parents of children with scoliosis: a qualitative descriptive study. Glob Qual Nurs Res 2021;8:23333936211045058.
crossref pmid pmc pdf


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