The Experts below are selected from a list of 579 Experts worldwide ranked by ideXlab platform
Burt Yaszay - One of the best experts on this subject based on the ideXlab platform.
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screening Intrathecal Baclofen Pump systems for catheter patency via catheter access port aspiration
Neuromodulation, 2020Co-Authors: Burt Yaszay, Andrew J Skalsky, Pritha Dalal, Joan Le, Emily EwingAbstract:OBJECTIVES: To screen all of our patients being treated with Intrathecal Baclofen (ITB) therapy for catheter patency. METHOD: Catheter patency was examined by performing a catheter access port study in 91 pediatric and adult patients undergoing ITB therapy at our institution. RESULTS: Despite no preoperative clinical suspicion of a problem with the ITB system in all but one case, 16.5% of the catheters in our patient population were not patent. After replacement, prerevision and stable postrevision dosage was examined to determine the impact system replacement had on the daily dosage. There was a significant 65% reduction in the daily ITB dosage from before catheter exploration (M = 823.8 mcg/day, SD = 390.51) to stable post replacement/revision dosage after catheter replacement or revision (M = 289.43 mcg/day, SD = 187.76), t11 = 4.09, p = .002, 95% CI [246.80, 822.00]. CONCLUSIONS: These results suggest that catheters need to be routinely screened for patency. Routine maintenance and screening can minimize or more quickly detect nonpatent systems and ensure proper functioning of the ITB system.
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screening Intrathecal Baclofen Pump systems for catheter patency via catheter access port aspiration
Neuromodulation, 2020Co-Authors: Burt Yaszay, Andrew J Skalsky, Pritha Dalal, Emily Ewing, Joan T LeAbstract:Objectives To screen all of our patients being treated with Intrathecal Baclofen (ITB) therapy for catheter patency. Method Catheter patency was examined by performing a catheter access port study in 91 pediatric and adult patients undergoing ITB therapy at our institution. Results Despite no preoperative clinical suspicion of a problem with the ITB system in all but one case, 16.5% of the catheters in our patient population were not patent. After replacement, prerevision and stable postrevision dosage was examined to determine the impact system replacement had on the daily dosage. There was a significant 65% reduction in the daily ITB dosage from before catheter exploration (M = 823.8 mcg/day, SD = 390.51) to stable post replacement/revision dosage after catheter replacement or revision (M = 289.43 mcg/day, SD = 187.76), t11 = 4.09, p = .002, 95% CI [246.80, 822.00]. Conclusions These results suggest that catheters need to be routinely screened for patency. Routine maintenance and screening can minimize or more quickly detect nonpatent systems and ensure proper functioning of the ITB system.
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Although inconvenient, Baclofen Pumps do not complicate scoliosis surgery in patients with cerebral palsy.
Spine, 2015Co-Authors: Burt Yaszay, Brian P Scannell, James D. Bomar, Paul D. Sponseller, Suken A. Shah, Jahangir Asghar, Amer F. Samdani, Tracey P. Bastrom, Peter O. NewtonAbstract:Study Design.Retrospective review of prospectively collected data.Objective.To compare patients with operative cerebral palsy with and without an Intrathecal Baclofen Pump (ITB) to determine whether an ITB increases the complexity of scoliosis surgery and/or increases the risk of wound complications
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scoliosis spinal fusion and Intrathecal Baclofen Pump implantation
Physical Medicine and Rehabilitation Clinics of North America, 2015Co-Authors: Brian P Scannell, Burt YaszayAbstract:: This article reviews the incidence, management, and complications of scoliosis in patients with cerebral palsy. Treatment of scoliosis in patients with cerebral palsy includes both nonoperative and operative management and often the decision to proceed with surgery is a multidisciplinary decision. Because of severe spasticity, many of these patients undergo Intrathecal Baclofen Pump placement before, during, or after posterior spinal fusion. The complication rates can be high with Intrathecal Baclofen Pump placement, but many patients can have significant benefit with this therapy.
Andrew J Skalsky - One of the best experts on this subject based on the ideXlab platform.
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screening Intrathecal Baclofen Pump systems for catheter patency via catheter access port aspiration
Neuromodulation, 2020Co-Authors: Burt Yaszay, Andrew J Skalsky, Pritha Dalal, Joan Le, Emily EwingAbstract:OBJECTIVES: To screen all of our patients being treated with Intrathecal Baclofen (ITB) therapy for catheter patency. METHOD: Catheter patency was examined by performing a catheter access port study in 91 pediatric and adult patients undergoing ITB therapy at our institution. RESULTS: Despite no preoperative clinical suspicion of a problem with the ITB system in all but one case, 16.5% of the catheters in our patient population were not patent. After replacement, prerevision and stable postrevision dosage was examined to determine the impact system replacement had on the daily dosage. There was a significant 65% reduction in the daily ITB dosage from before catheter exploration (M = 823.8 mcg/day, SD = 390.51) to stable post replacement/revision dosage after catheter replacement or revision (M = 289.43 mcg/day, SD = 187.76), t11 = 4.09, p = .002, 95% CI [246.80, 822.00]. CONCLUSIONS: These results suggest that catheters need to be routinely screened for patency. Routine maintenance and screening can minimize or more quickly detect nonpatent systems and ensure proper functioning of the ITB system.
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screening Intrathecal Baclofen Pump systems for catheter patency via catheter access port aspiration
Neuromodulation, 2020Co-Authors: Burt Yaszay, Andrew J Skalsky, Pritha Dalal, Emily Ewing, Joan T LeAbstract:Objectives To screen all of our patients being treated with Intrathecal Baclofen (ITB) therapy for catheter patency. Method Catheter patency was examined by performing a catheter access port study in 91 pediatric and adult patients undergoing ITB therapy at our institution. Results Despite no preoperative clinical suspicion of a problem with the ITB system in all but one case, 16.5% of the catheters in our patient population were not patent. After replacement, prerevision and stable postrevision dosage was examined to determine the impact system replacement had on the daily dosage. There was a significant 65% reduction in the daily ITB dosage from before catheter exploration (M = 823.8 mcg/day, SD = 390.51) to stable post replacement/revision dosage after catheter replacement or revision (M = 289.43 mcg/day, SD = 187.76), t11 = 4.09, p = .002, 95% CI [246.80, 822.00]. Conclusions These results suggest that catheters need to be routinely screened for patency. Routine maintenance and screening can minimize or more quickly detect nonpatent systems and ensure proper functioning of the ITB system.
Marion L Walker - One of the best experts on this subject based on the ideXlab platform.
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Posterior cervical approach for Intrathecal Baclofen Pump insertion in children with previous spinal fusions. Technical note.
Journal of neurosurgery, 2020Co-Authors: Marion L WalkerAbstract:Intrathecal Baclofen Pumps for the management of severe spasticity are being used more often in children with cerebral palsy. The Intrathecal catheter is traditionally introduced dorsally in the lumbar region. In some children with previous thoracolumbar fusions for scoliosis, the fusion mass obviates the introduction of the Intrathecal catheter. The authors describe their experience with a posterior cervical approach for Intrathecal Baclofen Pump insertion in three patients with spastic quadriplegic cerebral palsy who had previously undergone thoracolumbar fusions for scoliosis. Insertion was successful in all three patients; no complications of catheter disconnection, catheter dislodgment, or cerebrospinal fluid leakage occurred. Follow-up review ranged from 10 to 28 months postoperatively (mean 17 months). The posterior cervical approach for Intrathecal Baclofen Pump insertion is a safe and effective alternative for patients who have previously undergone thoracolumbar spine fusions and in whom the traditional lumbar approach is not feasible.
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surgical treatment of spasticity in children comparison of selective dorsal rhizotomy and Intrathecal Baclofen Pump implantation
Childs Nervous System, 2008Co-Authors: Judith L Gooch, Marion L Walker, Aminullah Amini, Diana Ploeger, Barbara Grams, Wende Oberg, Sara E Simonsen, John R W KestleAbstract:Introduction Neurosurgical treatments for spasticity in children include the traditional selective dorsal rhizotomy (SDR) and Intrathecal Baclofen Pumps (ITBPs), which have been widely used in the past decade as an attractive alternative. The purpose of the study was to examine and compare the outcomes of these two procedures in the treatment of children with severe spasticity.
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posterior cervical approach for Intrathecal Baclofen Pump insertion in children with previous spinal fusions technical note
Journal of Neurosurgery, 2005Co-Authors: Marion L WalkerAbstract:P Intrathecal Baclofen Pumps for the management of severe spasticity are being used more often in children with cerebral palsy. The Intrathecal catheter is traditionally introduced dorsally in the lumbar region. In some children with previous thoracolumbar fusions for scoliosis, the fusion mass obviates the introduction of the Intrathecal catheter. The authors describe their experience with a posterior cervical approach for Intrathecal Baclofen Pump insertion in three patients with spastic quadriplegic cerebral palsy who had previously undergone thoracolumbar fusions for scoliosis. Insertion was successful in all three patients; no complications of catheter disconnection, catheter dislodgment, or cerebrospinal fluid leakage occurred. Follow-up review ranged from 10 to 28 months postoperatively (mean 17 months). The posterior cervical approach for Intrathecal Baclofen Pump insertion is a safe and effective alternative for patients who have previously undergone thoracolumbar spine fusions and in whom the tr...
Michael Vloeberghs - One of the best experts on this subject based on the ideXlab platform.
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selective dorsal rhizotomy as an alternative to Intrathecal Baclofen Pump replacement in gmfcs grades 4 and 5 children
Childs Nervous System, 2016Co-Authors: Harshal Ingale, Ismail Ughratdar, Samiul Muquit, Ahmad A Moussa, Michael VloeberghsAbstract:Background Conventionally, selective dorsal rhizotomy (SDR) has been reserved for ambulant children and implantation of Intrathecal Baclofen (ITB) Pump for non-ambulant children with cerebral palsy. Rather than replacing the ITB Pump in selected Gross Motor Function Classification System (GMFCS) grades 4 and 5 children, we elected to undertake SDR instead. We discuss the rationale and outcomes.
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cervical implantation of Intrathecal Baclofen Pump catheter in children with severe scoliosis
Journal of Neurosurgery, 2012Co-Authors: Ismail Ughratdar, Samiul Muquit, Harshal Ingale, Ahmad A Moussa, Amr Ammar, Michael VloeberghsAbstract:Object Intrathecal Baclofen (ITB) Pump catheter placement is traditionally performed through entry into the spinal sac at the lumbar spine. A minority of children with cerebral palsy have severe concomitant neuromuscular scoliosis. In these children, whether surgically treated or not, access to the intradural space via the lumbar spine may prove technically challenging. The authors report on a series of children in whom, for various reasons, an ITB catheter was implanted using a posterior cervical spine approach. Methods The records of 20 children in whom a Baclofen catheter had been placed were retrospectively reviewed to assess the demographic details, indications, and outcome of this procedure. Results This approach was successful in all but one of the children in whom the procedure was abandoned given the presence of significant extradural scar tissue. Of the 20 children, 7 had previously undergone lumbar ITB catheter implantation, although the catheter was subsequently, iatrogenically transected duri...
Dobrivoje S Stokic - One of the best experts on this subject based on the ideXlab platform.
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Neurophysiologic evaluation of spastic hypertonia: implications for management of the patient with the Intrathecal Baclofen Pump.
American journal of physical medicine & rehabilitation, 2020Co-Authors: Stuart A Yablon, Dobrivoje S StokicAbstract:A number of techniques attempt to objectively quantify various clinical characteristics associated with spastic hypertonia and related motor disorders. These range in cost, complexity, physiologic basis of measured response, and invasiveness. With a greater range of treatment options for spasticity and an increase in the number of centers participating in studies of interventions for spasticity, published reports reflect increasing use of objective quantification techniques. We review studies that highlight the potential utility of neurophysiologic techniques, including the H-reflex, F-wave, and flexion withdrawal reflex, in the objective evaluation of response to Intrathecal Baclofen administration. The accumulated knowledge suggests that neurophysiologic evaluation is useful for assessing spinal cord responsiveness, and we recommend it as an adjunct to clinical evaluation when judging the overall effectiveness of Intrathecal Baclofen administration.
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neurophysiologic evaluation of spastic hypertonia implications for management of the patient with the Intrathecal Baclofen Pump
American Journal of Physical Medicine & Rehabilitation, 2004Co-Authors: Stuart A Yablon, Dobrivoje S StokicAbstract:ABSTRACT Yablon SA, Stokic DS: Neurophysiologic evaluation of spastic hypertonia: Implications for management of the patient with the Intrathecal Baclofen Pump. Am J Phys Med Rehabil 2004;83(suppl):S10–S18. A number of techniques attempt to objectively quantify various clinical characteristics associated with spastic hypertonia and related motor disorders. These range in cost, complexity, physiologic basis of measured response, and invasiveness. With a greater range of treatment options for spasticity and an increase in the number of centers participating in studies of interventions for spasticity, published reports reflect increasing use of objective quantification techniques. We review studies that highlight the potential utility of neurophysiologic techniques, including the H-reflex, F-wave, and flexion withdrawal reflex, in the objective evaluation of response to Intrathecal Baclofen administration. The accumulated knowledge suggests that neurophysiologic evaluation is useful for assessing spinal cord responsiveness, and we recommend it as an adjunct to clinical evaluation when judging the overall effectiveness of Intrathecal Baclofen administration.