Effective botulinum neurotoxin injection in treating iliopsoas spasticity

Abstract

Introduction To detect ideal locations for botulinum toxin (BoNT) injection by exploring the intramuscular nerve arborization of the psoas major and iliacus muscles. Method A modified Sihler's method was performed on the psoas major and iliacus muscles (16 specimens each). Intramuscular nerve arborization was recorded according to the most prominent point of the anterior superior iliac spine (ASIS), the posterior superior iliac spine (PSIS), the lesser trochanter (LT), and the transverse process of the 12th thoracic vertebra. Results Intramuscular nerve arborization of the psoas major muscle was the largest from 1/5 to 3/5 the distance from the transverse process of the 12th thoracic vertebra to the PSIS, and the tendinous portion of the muscle occupied from 3/5 to 5/5 this distance. In terms of the plane of the ASIS, the PSIS, and the LT, the arborization of the iliacus muscle was the largest from 1/5 to 3/5 the horizontal distance and 0 to 1/3, the distance longitudinally, and from 1/5 to 2/5, the horizontal distance and 1/3 to 2/3, the longitudinal distance. Discussion These results suggest that an injection of BoNT to the psoas major and iliacus muscle should be applied in specific areas. Additionally, the posterior approach is an ideal method for targeting only the psoas major because the injection point is above the PSIS. However, when treating both the psoas major and iliacus muscles, the proximal anterior approach is an ideal method according to the arborization patterns.

The botulinum neurotoxin for pain control after breast reconstruction: neural distribution of the pectoralis major muscle

“…Consequently, to enhance the effectiveness and mitigate the negative effects of BoNT injection, it needs to be made directly into the neural arborized areas. To determine the injection spot for BoNT, studies have concentrated on finding the neural arborized areas within the muscles 17–22. Additionally, previous studies have reported neurological damage resulting from mechanical injury when injection treatments have been performed at the nerve trunk, in the place where the nerve punctures into muscle tissue 23…”

Intramuscular Neural Arborization of the Latissimus Dorsi Muscle: Application of Botulinum Neurotoxin Injection in Flap Reconstruction

“…Thus, to lessen the undesirable effects and enhance efficiency, LD muscle BoNT injection should be targeted into the neural arborized zones. Studies have focused primarily on identifying the intramuscular arborized zones and guidance injectable points for BoNT treatments [35][36][37][38][39][40][41][42][43][44][45].…”

Anatomical locations of the motor endplates of sartorius muscle for botulinum toxin injections in treatment of muscle spasticity

“…Studies that explain BoNT injection locations by navigating intramuscular neural distribution with naked eye dissection have limits, such as perceiving minuscule nerves and the likelihood of neural damage [17,21,25,[41][42][43][44][45][46][47][48][49].…”