Intrathecal baclofen, neuro-orthopedic surgery and head injuries: when?
Dr Flavia Oana COROIANa
a Département MPR, CHU Lapeyronie Montpellier
The neuro-orthopedic disorders are a common complication in patients with brain injury, with multiple consequences on the awakening, nursing, pain and functional recovery.
Intrathecal baclofen therapy can be provided to a diffuse and troublesome hypertonia, at different stages of evolution after head injury.
It can be initiated in early phase, within 6 months post trauma, for the treatment of hypertonia and treatment of autonomic crises. At this stage, intrathecal baclofen may have a role in the prevention of neuro-orthopedic disorders secondary to hypertonia and muscle and tendon contractures.
At late stage after brain injury, treatment with intrathecal baclofen and orthopedic surgery can be offered alone or in combination. We will present the clinical elements, the additional assessment tests and other factors that will enable the multidisciplinary team to set the treatment goals and to guide therapeutic choices.
At what point in the evolution therapy by intrathecal baclofen and / or surgery (neuro) -orthopédique can be offered in brain injury?
What timeline if combination therapy: baclofen intrathecal before neuro-orthopedic surgery or neuro-orthopedic surgery before intrathecal baclofen?
Should a test to intrathecal baclofen be considered systematically before any neuro-orthopaedic surgery ?
Keywords : Brain injury, intrathecal baclofen, neuro-orthopedic surgery