Disclosures: Daniel C. Oh, MD, MS: Nothing to disclose

Case Description: This patient initially presented with functional deterioration secondary to SPS with intractable muscle spasms in the bilateral lower extremities, low back, and right upper extremity, which was recalcitrant to oral anti-spasmodics. As such, an intrathecal baclofen (ITB) pump was placed with the catheter tip at the T10 level and over a 5-year period, the patient had reduced spasms and return to function with ITB dose titration. However, in the subsequent 6 months following the improved function, the patient noted rapid progression of low back pain and gait instability. Before and after implantation x-ray imaging demonstrated a progression of thoracic dextroscoliosis with a Cobb angle of 40 degrees (from 10 degrees, 5 years prior) and lumbar levoscoliosis with Cobb angle of 50 degrees (from 8 degrees, 5 years prior). X-ray also revealed left lateral subluxation of L4 on L5 and L3 on L4 as well as grade 1 retrolisthesis of L3-4 and grade 1 anterolisthesis of L4-5. DEXA scan showed low bone density. Neurosurgical evaluation resulted in recommendation for spinal reconstruction.

Setting: Outpatient center.

Patient: A 59-year-old woman with chronic inflammatory demyelinating polyneuropathy (CIDP), stiff person syndrome (SPS), and thoracolumbar S-shaped scoliotic curvature.

Assessment/Results: Although the patient’s spasms and spasticity were well-controlled on ITB, she experienced accelerated progression of her thoracolumbar S-shaped scoliotic curvature into severe thoracolumbar scoliosis, requiring surgical intervention.

Discussion: Although accelerated progression of scoliosis after ITB placement has been described in children with cerebral palsy, this is the first reported case, to our knowledge, of this phenomenon in a patient with SPS.

Conclusion: Accelerated progression of scoliosis should be a consideration when treating spasticity with ITB in the adult population.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/advanced-progression-of-scoliosis-after-intrathecal-baclofen-in-an-adult-with-stiff-person-syndrome-a-case-report/