Name of the Procedure:

Chemodenervation of Trunk Muscle(s); 6 or More Muscles
Common Name(s): Botulinum Toxin Injection, Botox Injection for Muscle Spasticity

Summary

Chemodenervation of trunk muscles involves injecting a chemical substance, such as botulinum toxin (commonly known as Botox), into six or more muscles of the trunk to reduce muscle spasticity or abnormal muscle contractions. This is typically a minimally invasive outpatient procedure.

Purpose

Chemodenervation is mainly used to treat muscle spasticity, often resulting from conditions such as spinal cord injuries, multiple sclerosis, or cerebral palsy. The goal of the procedure is to relax the targeted muscles, thereby reducing pain, improving posture, and increasing functional ability.

Indications

• Persistent muscle spasms or spasticity in the trunk area
• Conditions like multiple sclerosis, cerebral palsy, and spinal cord injuries
• Chronic pain associated with muscle overuse

Preparation

• Patients may need to avoid certain medications, such as blood thinners, for a few days before the procedure.
• Pre-procedure assessments, including a physical exam and possibly imaging studies, are conducted to identify the specific muscles to be treated.
• Fasting is generally not required unless sedation is planned.

Procedure Description

1. The patient is positioned comfortably, and the skin over the injection sites is cleaned and sterilized.
2. A small needle is used to inject botulinum toxin into each of the identified muscles.
3. The procedure might utilize electromyography (EMG) or ultrasound guidance to ensure accurate placement of the injections.
4. Depending on the patient's need, local anesthesia or mild sedation may be administered to minimize discomfort.

Duration

The procedure usually takes about 30 to 60 minutes, depending on the number of muscles being treated.

Setting

Chemodenervation is typically performed in an outpatient clinic or a specialized medical center.

Personnel

• A neurologist or a physical medicine and rehabilitation physician typically performs the procedure.
• A nurse or medical assistant may be present to assist.

Risks and Complications

• Common risks: bruising, pain at the injection site, temporary weakness
• Rare risks: allergic reactions, infection, unintended muscle paralysis
• Possible complications are managed through supportive care and follow-up visits.

Benefits

• Reduction in muscle spasticity, leading to decreased pain and improved functional mobility
• Effects are usually noticeable within a few days to a week and may last several months

Recovery

• Patients can usually go home shortly after the procedure.
• Mild soreness at the injection sites can be managed with over-the-counter pain medications.
• Normal activities can often be resumed within a day or two, although strenuous activities should be avoided for a few days.
• Follow-up appointments may be necessary to assess the effectiveness of the treatment and determine if additional injections are required.

Alternatives

• Physical therapy and exercise
• Oral muscle relaxants or antispasticity medications
• Surgical interventions in severe cases
• Pros: Non-invasive options like physical therapy carry fewer risks
• Cons: Alternatives may not be as effective in severe cases or may have other side effects

Patient Experience

During the procedure, the patient might feel mild discomfort from the needle pricks. Post-procedure, some soreness and temporary weakness can be expected. Pain management, if needed, is generally minimal and effective with over-the-counter medications. Most patients report significant relief from spasticity and improved quality of life within a week following the injections.