Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2020; 11(10): 453-464
Published online Oct 18, 2020. doi: 10.5312/wjo.v11.i10.453
Long-term effect of intrathecal baclofen treatment on bone health and body composition after spinal cord injury: A case matched report
Dora E Ifon, Mina P Ghatas, John C Davis, Refka E Khalil, Robert A Adler, Ashraf S Gorgey
Dora E Ifon, Mina P Ghatas, John C Davis, Refka E Khalil, Ashraf S Gorgey, Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, Richmond, VA 23249, United States
Robert A Adler, Medical Service, Central Virginia VA Health Care System, Richmond, VA 23249, United States
Robert A Adler, Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University, Richmond, VA 23298, United States
Ashraf S Gorgey, Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23298, United States
Author contributions: All authors contributed to the writing and revising of the manuscript.
Supported by the DoD-CDRMP, No. W81XWH-14-SCIRP-CTA.
Informed consent statement: Informed written consent was obtained.
Conflict-of-interest statement: No conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ashraf S Gorgey, PhD, Physiotherapist, Professor, Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA 23249, United States. ashraf.gorgey@va.gov
Received: June 2, 2020
Peer-review started: June 2, 2020
First decision: July 4, 2020
Revised: July 15, 2020
Accepted: September 10, 2020
Article in press: September 10, 2020
Published online: October 18, 2020
Abstract
BACKGROUND

Severe spasticity may negatively impact functionality and quality of life after spinal cord injury (SCI). Intrathecal baclofen treatment (IBT) is effectively used to manage severe spasticity and reduce comorbidities. However, long-term IBT may have a negative effect on bone mineral content (BMC), bone mineral density (BMD) and body composition (such as percentage fat mass and lean body mass). We demonstrated the negative effects of long-term IBT use in a single case compared with two non-IBT users.

CASE SUMMARY

A 46-year old Caucasian male Veteran (case) with a 21 year history of complete tetraplegia (complete C6 SCI) was implanted with IBT for 20 years. The case was matched to two participants with different time since injuries [2 (match 1) and 13 (match 2) years] without IBT. Knee BMC and BMD at the epiphysis and metaphysis of the distal femur and proximal tibia were evaluated using dual knee and the dual femur modules of GE Lunar iDXA software. Total and leg body composition assessments were also conducted for the three participants. Potential effect of long-term IBT was demonstrated by changes in BMD, consistent with bone demineralization, at the distal femur and proximal tibia and changes in percentage fat mass and lean mass of legs. The case showed 113% lower BMD at the distal femur, and 78.1% lower at the proximal tibia compared to match 1, moreover the case showed 45% lower BMD at the distal femur, and no observed changes at the proximal tibia compared to match 2. The case had 27.1% and 16.5% greater leg %fat mass compared to match 1 and match 2, respectively. Furthermore, the case had 17.4% and 11.8% lower % leg lean mass compared to match 1 and match 2, respectively.

CONCLUSION

Long-term IBT may impact bone health and body composition parameters in persons with complete SCI. It may be prudent to encourage regular screening of individuals on long-term IBT considering the prevalence of osteoporosis related fractures, cardiovascular diseases, and metabolic disorders in this population.

Keywords: Intrathecal baclofen, Spasticity, Bone mineral density, Epiphysis, Metaphysis, Spinal cord injury, Case report

Core Tip: The long-term effects of intrathecal baclofen treatment (IBT) on bone mineral density and body composition profile were investigated in a man with spinal cord injury compared to two matched participants with different age and time since injury. Bone mineral density loss was greater at the distal femur and proximal tibia compared to the matches without IBT. Furthermore, the case had greater percentage leg fat mass and lower percentage lean mass compared to both matches. The negative side effects of IBT implantation warrant further studies considering the prevalence of osteoporosis related fractures, cardiovascular diseases, and metabolic disorders in this population.