Botulinum toxin type A treatment of hip and thigh spasticity: a technique for injection of psoas major muscle

Spasticity of the hip and thigh can result from spinal cord injury, multiple sclerosis, cerebral palsy and numerous other neurological conditions. Chronic hip spasticity causes the patient extreme difficulty in walking and maintaining a comfortable posture. First-line treatment usually consists of oral anti-spastic agents, although these are often associated with a high side-effect burden. Intramuscular injections of botulinum toxin type A (BTS-A), particularly into the psoas major muscle, have proved to be of functional benefit to the patient. A highly reliable and reproducible method for injecting the psoas major muscle through a para-spinal route has been developed to reduce the power of the muscle and hip flexion deformity. Injection occurs through the middle of the erector spinae muscle at L2, L3 and L4, delivering a total of 150 U BTX-A to the psoas major muscle. Follow-up with a substantial rehabilitation programme reliably ensures a decrease in Modified Ashworth Scores and improvements in the outcome assessment scores measured, Eur J Neurol 6 (suppl 4):S91-S93 (C) Lippincott Williams & Wilkins.