Name of the Procedure:

Chemodenervation of trunk muscle(s); 1-5 muscle(s)

Summary

Chemodenervation of the trunk muscles is a minimally invasive procedure where muscle relaxants, usually botulinum toxin (Botox), are injected into 1 to 5 muscles in the trunk area. This treatment is used to temporarily reduce muscle activity.

Purpose

• Medical Condition: Treats conditions like muscle spasticity, chronic pain, or dystonia affecting the trunk muscles.
• Goals: To alleviate muscle tightness and spasms, reduce pain, and improve mobility and function of the trunk muscles.

Indications

• Symptoms: Severe muscle spasms, chronic pain, dystonia, and muscle rigidity in the trunk area.
• Patient Criteria: Patients who have not responded well to other treatments such as physical therapy or oral medications.

Preparation

• Pre-procedure Instructions: Patients may be advised to avoid blood thinners or certain medications a few days before the procedure. Fasting is generally not required.
• Diagnostic Tests: A physical examination and possibly imaging tests like MRI or CT scans to identify the affected muscles.

Procedure Description

1. The area of injection is cleaned and sanitized.
2. The physician might use EMG (electromyography) or ultrasound guidance to precisely locate the muscles.
3. A small amount of botulinum toxin is injected into each of the identified muscles.
4. The procedure may involve a few injections, depending on the number of muscles being treated.
   • Tools: Needles for injection, EMG or ultrasound for guidance.
   • Anesthesia: Usually, no anesthesia is required, but a local anesthetic may be applied to the injection sites.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Usually performed in an outpatient clinic or a doctor's office.

Personnel

• A specialist physician (e.g., neurologist, physiatrist, or pain management doctor).
• A nurse to assist the doctor.
• Occasionally a technician to operate the EMG or ultrasound equipment.

Risks and Complications

• Common Risks: Minor pain or bruising at the injection site, temporary weakness in the treated muscles.
• Rare Risks: Allergic reactions, infection, unintended spread of the toxin causing weakness in surrounding muscles.
• Complications Management: Pain is usually managed with over-the-counter analgesics; unusual symptoms should be reported to the physician immediately.

Benefits

• Expected Benefits: Reduced muscle spasms and pain, improved mobility.
• Realization Time: Effects are usually noticed within a few days to a week and can last from 3 to 6 months.

Recovery

• Post-Procedure Care: Patients can usually return to normal activities immediately but should avoid strenuous activities for a few days.
• Recovery Time: Most patients recover fully within a couple of days with minimal restrictions.
• Follow-Up: Typically, a follow-up appointment is scheduled to assess the effectiveness and determine if further treatment is needed.

Alternatives

• Other Treatment Options: Oral muscle relaxants, physical therapy, surgical interventions.
• Pros and Cons: Oral medications might have systemic side effects, physical therapy may take longer to show results, surgery is more invasive and carries higher risks.

Patient Experience

• During Procedure: Most patients experience minimal discomfort, similar to a flu shot.
• After Procedure: Some soreness at injection sites; usual activities can be resumed typically on the same day. Pain management includes over-the-counter pain relievers if necessary.