Baclofen pump implantation for cerebral palsy Cerebral palsy is often referred to as “cerebral palsy”. Medically speaking, cerebral palsy is a non-progressive brain injury caused by various reasons from before birth to one month after birth, which no longer progresses and is stationary. Although we say cerebral palsy, the main manifestation of cerebral palsy is limb movement disorder and abnormal posture during movement, while many children with cerebral palsy often have normal intellectual performance. The causes of cerebral palsy may be diverse, and although there is a lot of research on the subject, to date the exact specific cause of the disease is not completely clear. Ischemia and hypoxia during prematurity may be the most important cause of cerebral palsy, as well as traumatic brain injury, developmental malformations, and postnatal jaundice. Cerebral palsy has a serious impact on the motor function of the child and has a high disability rate, which seriously affects the quality of life of the child and his or her family. Cerebral palsy is usually divided into spastic, tardive dyskinesia, tonic, ataxic, hypotonic, and mixed types. The spastic type accounts for 60-70% of patients, the tardive dyskinesia type accounts for 20% of patients, and the remaining types are rare. The most fundamental cause of limb movement symptoms in cerebral palsy is the loss of control of the central nervous system over the detrusor reflexes of the limbs, resulting in abnormalities in normal reflexes that are gradually aggravated. In response to this mechanism, various surgical treatments for cerebral palsy have emerged. Baclofen is an inhibitory neurotransmitter of the central nervous system, which controls some of the body’s reflexes through baclofen. Patients with cerebral palsy experience a loss of CNS control over the body’s reflexes, which means that baclofen cannot be released to inhibit excessive neural reflexes. To address this mechanism, cerebral palsy can be treated by artificially rationing baclofen into the subarachnoid space to control abnormal reflexes. Baclofen pumps were first used by Penn and Kroin in 1984 to treat limb spasms, and have since been used extensively in the treatment of cerebral palsy. The baclofen pump allows for controlled and quantitative infusion of baclofen into the spinal canal. Baclofen pump implantation can treat spastic cerebral palsy by significantly reducing muscle tone and improving symptoms, and the dose can be adjusted according to the degree of improvement of the patient’s symptoms. Compared to selective posterior spinal nerve rhizotomy, baclofen pump implantation is less invasive and non-destructive, but is more expensive and requires battery replacement and regular drug infusion into the pump. For this reason, baclofen pumps are often used more often in patients with spastic cerebral palsy who have severe spasticity of the extremities and cannot walk. In addition to treating spastic cerebral palsy, baclofen pump implantation can also treat mixed cerebral palsy, especially when it is associated with torsion and spasticity. Unlike spastic cerebral palsy alone, mixed cerebral palsy is very difficult to treat, and the most effective treatment at this time would be baclofen pump implantation. For patients who need to improve their spasticity, a trial is needed to determine if baclofen input will improve the patient’s symptoms before implanting a baclofen pump. The test can be performed in the awake state by giving the patient a lumbar puncture and then injecting an amount of baclofen into the spinal canal at once and then observing if it improves the spasticity of the child. If it works, then most patients will have an effect after the baclofen pump is implanted. In children with torsional spasticity, a trial is often not necessary and baclofen pump implantation can often be performed directly. Families need to be aware that baclofen pump implantation is a minimally invasive procedure with no nerve damage, but it is much more expensive than selective posterior spinal nerve rhizotomy, and the battery needs to be replaced in about 6 years, and the pump needs to be reinjected with baclofen at least annually, which means that the cost of baclofen medication needs to be paid annually. The best candidates for baclofen pump implantation would be mixed cerebral palsy and torsion spasticity cerebral palsy.