Intrathecal Baclofen Pump (ITB)

an approach to managing severe spasticity within functional neurosurgery

What is an intrathecal baclofen pump and why it is considered

An intrathecal baclofen pump (ITB) is a functional neurosurgical approach used to manage severe muscle spasticity associated with disorders of the central nervous system.

The method is based on delivering baclofen directly into the intrathecal space of the spinal cord through an implanted system.
This allows targeted action on the mechanisms of spasticity while reducing systemic drug exposure.

It is important to clarify from the outset: an intrathecal baclofen pump does not treat the underlying neurological condition. It is used to control one of its key manifestations — pathological muscle tone.

Clinical situations in which ITB may be discussed

An intrathecal baclofen pump may be considered in neurological conditions accompanied by severe, poorly controlled spasticity, including:

• cerebral palsy (spastic forms)
• consequences of spinal cord injury
• multiple sclerosis and other demyelinating disorders
• severe forms of dystonia
• sequelae of infectious involvement of the central nervous system
• post-stroke spasticity or other brain and spinal cord injuries — in selected cases

In some situations, ITB may also be discussed in complex forms of neuropathic pain, although such cases require particularly careful evaluation.

Why spasticity should not be approached superficially

Spasticity is not simply “tight muscles.” It reflects impaired regulation of motor signals within the central nervous system.

When spasticity is pronounced, patients and families often face:

• significant limitations in mobility
• chronic discomfort or pain
• difficulties with daily care
• reduced effectiveness of rehabilitation

The goal of considering ITB is to create more controllable conditions, in which movement, care, and rehabilitation become more achievable.

How the decision about an intrathecal baclofen pump is made 

An intrathecal baclofen pump is not a standard solution and is not suitable for every patient.

Evaluation is comprehensive and typically includes:

• neurological assessment
• review of previously attempted treatments
• functional status of the patient
• rehabilitation potential
• realistic goals defined by the patient or family

At this stage, many patients — both locally and from abroad — seek a second professional opinion to understand whether ITB is a reasonable option or whether alternative approaches should be considered.

How the system works

The intrathecal baclofen pump system consists of:

• a reservoir containing the medication
• a catheter delivering baclofen into the intrathecal space

Once implanted, the system provides continuous, precisely controlled delivery of baclofen directly to spinal cord structures.
Dosing can be adjusted programmatically without removing the device.

This mode of administration allows:

• lower overall drug doses
• fewer systemic side effects
• flexible adaptation of therapy to the clinical situation

The procedure and ongoing follow-up

Implantation of an intrathecal baclofen pump is a neurosurgical procedure and requires ongoing follow-up.

After implantation, the system requires:

• regular dose adjustments
• monitoring of device function
• scheduled refilling of the medication

For this reason, already at the consultation stage it is important to assess not only medical indications, but also the feasibility of long-term follow-up and care.

Rehabilitation as an essential component

An intrathecal baclofen pump does not work in isolation. Without rehabilitation, its clinical value remains limited.

After implantation, a structured rehabilitation program is required, focusing on:

• learning new movement strategies
• strengthening muscles
• prevention of secondary complications

The combination of spasticity control and rehabilitation largely determines the final functional outcome.

Alternative approaches that may also be discussed

If ITB is not appropriate in a specific clinical situation, other options may be considered, including:

• selective dorsal rhizotomy (SDR)
• neuromodulation techniques
• individually tailored conservative strategies

The purpose of consultation is not to promote a specific method, but to determine which path makes clinical sense.

Who may benefit from a consultation

Consultation regarding an intrathecal baclofen pump is often relevant for patients and families who:

• are dealing with severe spasticity that responds poorly to medication
• have received differing or conflicting recommendations
• want to understand which options realistically exist in their situation
• are planning next steps and need a structured clinical evaluation

For patients living outside the country, consultation often begins with a review of medical records and prior treatments, helping to assess the appropriateness of further steps.

Next step

When spasticity significantly affects movement and daily function, it is important to start not with a decision of “yes or no,” but with understanding the clinical picture.

A neurological consultation helps:

• clarify the underlying mechanisms of spasticity
• evaluate what has already been tried
• determine whether discussing an intrathecal baclofen pump or alternative approaches is appropriate

In many cases, this step alone brings clarity to the decision-making process.

Consultations and contact

📞 Phone: +972-73-374-6844
📧 Email: [email protected]
💬 WhatsApp: +972-52-337-3108