Medical Student Baylor College of Medicine Houston, TX, US
Introduction: Patients with cerebral palsy (CP) are often underweight, partly due to high energy expenditure from uncontrolled spasticity. Intrathecal baclofen pump (ITB) is a common procedure performed to decrease spasticity. Previous studies have investigated the impact of ITB on weight gain and have shown mixed results. This study aimed to investigate the effect of ITB surgery on BMI trajectory over time as a proxy for energy expenditure.
Methods: Patients diagnosed with CP who underwent ITB placement at Texas Children’s Hospital over the past 13 years were retrospectively reviewed. Pre- and post-operative BMI values, demographic information, and potential confounders were collected. Multiple BMI rates of change were calculated per patient, ensuring at least 30 days between each calculation, and standardized to an annual rate. A linear mixed effects model was used to account for intra-patient variability and capture the pre-operative picture. Subgroup analyses were performed to identify significant influencers.
Results: A total of 252 patients were included after excluding incomplete data. The average BMI rate of change was 0.54 kg/m²/year (SD 3.49) pre-surgery and 0.49 kg/m²/year (SD 3.47) post-surgery, showing no significant difference (p = 0.73). The mixed effects model found no statistically significant effect of ITB surgery on BMI rate of change by catheter level. Specifically, cervical (0.132, p = 0.604), high thoracic (−0.139, p = 0.511), mid thoracic (-0.295, p = 0.421), and low thoracic (0.059, p = 0.852) levels were non-significant. Subgroup analyses revealed similar non-significant findings for all potential confounders.
Conclusion : ITB surgery, regardless of catheter placement, does not significantly affect BMI rate of change in the postoperative period. This may indicate that even with adequate tone control, CP patients do not experience changes in energy expenditure, and further management may be necessary to ensure optimal BMI.
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