Spasticity is a condition characterized by abnormal muscle stiffness and involuntary contractions due to injury or dysfunction of the brain or spinal cord. It commonly occurs in patients with cerebral palsy, spinal cord injury, multiple sclerosis, traumatic brain injury, or stroke. When oral medications and physiotherapy are not sufficient, advanced neurosurgical options — such as intrathecal baclofen (ITB) pump therapy — can provide safe and effective long-term relief.
Understanding Spasticity
Spasticity results from an imbalance between excitatory and inhibitory signals in the central nervous system, leading to overactive reflexes and continuous muscle contraction. This can cause:
- Stiffness or tightness of limbs
- Painful muscle spasms
- Abnormal posture or joint deformity
- Difficulty walking, dressing, or performing daily activities
- Increased risk of skin injury and contractures
Managing spasticity is essential not only for comfort but also for mobility, hygiene, and long-term joint health.
Treatment Options
1. Conservative Management
- Physical therapy and stretching
- Oral antispasticity medications:
Baclofen, tizanidine, diazepam, dantrolene
- Botulinum toxin (Botox) injections for focal spasticity
Oral medications often cause sedation or weakness and may not provide sufficient relief in severe or generalized spasticity.
2. Intrathecal Baclofen (ITB) Pump Therapy
The intrathecal baclofen pump delivers tiny doses of medication directly into the spinal fluid, bypassing the bloodstream and minimizing side effects. This allows powerful muscle relaxation with far lower doses than oral therapy.
How It Works:
- The pump continuously releases baclofen, a muscle relaxant that inhibits excessive nerve signaling in the spinal cord
- A catheter is placed in the intrathecal space, connected to a programmable pump implanted under the skin of the abdomen
- The device is adjusted wirelessly to optimize dosage for each patient
- The reservoir is refilled every 2–3 months using a simple outpatient injection
Benefits:
- Significant reduction in spasticity and spasms
- Improved mobility, sitting balance, and care comfort
- Reduced need for oral medications
- Better sleep quality and hygiene management
- Reversible and adjustable therapy
3. Selective Dorsal Rhizotomy (SDR) (in children with cerebral palsy)
In carefully selected pediatric patients, Selective Dorsal Rhizotomy may be performed to reduce spasticity permanently.
- Involves cutting a small number of sensory nerve rootlets in the lower spine that contribute to overactive reflexes
- Performed under microscopic guidance with neurophysiological monitoring
- Typically combined with postoperative physiotherapy for functional improvement
SDR is usually indicated in children with spastic diplegia and preserved motor potential.
Candidates for Intrathecal Pump Therapy
- Generalized spasticity resistant to oral medications
- Spasms causing pain, deformity, or impaired daily function
- Good cognitive function and caregiver support
- Positive response to a screening test dose of intrathecal baclofen
Procedure
1. Screening Test
A single dose of baclofen is injected into the spinal fluid to evaluate reduction in tone and improvement in comfort or mobility. If results are positive, permanent implantation is planned.
2. Pump Implantation
- Performed under general or regional anesthesia
- A small incision places the catheter into the intrathecal space and tunnels it to the abdominal pump pocket
- The programmable pump is filled and calibrated before closure
- Procedure typically takes 1–2 hours, with a 2–3 day hospital stay
3. Postoperative Adjustment
Doses are gradually titrated over several weeks to achieve the best balance between tone reduction and strength preservation.
Risks & Complications
- Infection or CSF leakage (minimized with sterile technique)
- Catheter disconnection or blockage
- Pump malfunction (correctable or replaceable)
- Withdrawal symptoms if medication delivery is interrupted (requires urgent attention)
Overall, complication rates are low, and modern pumps are highly reliable and MRI-compatible.
Recovery & Follow-Up
- Hospital stay: 2–5 days
- Rehabilitation: starts immediately postoperatively to maximize benefit
- Pump refill: every 2–3 months via a quick outpatient procedure
- Battery life: 5–7 years (rechargeable models last longer)
- Regular follow-up ensures safe function and optimal dose adjustment
Combined with physiotherapy, ITB therapy significantly enhances mobility, comfort, and daily independence.
Patient Advisory
Spasticity management requires individualized treatment planning by a multidisciplinary team — including neurosurgeons, physiatrists, and physical therapists. Not all patients are candidates for pump therapy; thorough assessment and trial testing are essential. Treatment goals are always patient-specific, balancing muscle tone reduction with preserved function. Do not rely solely on online information — consult your neurosurgeon or rehabilitation specialist for personalized evaluation.