Ultrasound‐guided injection of the iliopsoas muscle with botulinum toxin in camptocormia

Abstract

Camptocormia is characterized by an abnormal posture of the trunk with pronounced flexion of the thoraco-lumbar spine during standing and walking, which abates in a supine position. Treatment options for camptocormia are limited and mostly futile. Here, we report on the ultrasound-guided ventral injection of botulinum toxin A (BTX) into deep portions of the iliopsoas muscle in four parkinsonian patients with camptocormia as chief complaint. Using this novel and safe application technique, all patients received 500-1,500 MU of BTX per side in 4-6 month intervals. Treatment was generally well tolerated. At the highest dose, all patients complained of mild weakness of hip flexion. Standardized physical exam at follow-up visits, as well as self-assessment of patients, failed to show a relevant and lasting improvement of posture. In conclusion, injection of BTX into the iliopsoas does not appear to be a promising approach for the treatment of parkinsonism-associated camptocormia.

Mechanism of camptocormia in Parkinson's disease analyzed by tilt table-EMG recording

“…With regard to the hip flexors, the frequency of muscle discharge was similar in the three groups. Lidocaine was injected into bilateral psoas majors in patients with LC based on a previous report [10], since the physiological action of this muscle is to flex the trunk at the hip joint, as shown in LC patients [11]. Body posture improved significantly in the majority of LC patients following the injection, suggesting that the psoas major is also somewhat involved in the development of LC.…”

Presentation, Etiology, Diagnosis, and Management of Camptocormia

“…Injections of botulinum toxin into the iliopsoas muscles may also relieve camptocormia [34]. In other patients with Parkinson-associated camptocormia, however, injection of botulinum toxin into the iliopsoas muscle was ineffective [72]. Botulinum toxin may not only be effective in patients with focal dystonia but also in patients with Parkinson’s disease [77].…”

“…Treatment options for camptocormia are limited and frequently futile [72]. Generally, treatment options may be classified as conservative or invasive (table 2).…”

Treatment of camptocormia with botulinum toxin

“…Injections of 500e1500 units of abobotulinum toxin A to the deep portion of iliopsoas of 3 PD and one MSA patient in another study resulted in some weakness of hip flexion and questionable efficacy (von Coelln et al, 2008). CT guidance to more accurately target the iliopsoas in a separate study of two patients, with rectus abdominis also treated, was also ineffective (Colosimo and Salvatori, 2009).…”