Doctor Institut medical sport sante Castelnau Le Lez, Languedoc-Roussillon, France
Case Diagnosis: Painful post surgical muscle spasms can occur after spinal surgery, often related to reflex muscular hyperactivity, local nerve irritation, or postoperative fibrosis. Botulinum toxin type A is well established in the treatment of dystonias, muscle spasms, and certain neuropathic pain conditions. However, its use for post surgical peri-scar spams is poorly documented. The aim of this case report is to present two cases of patients who underwent thoracolumbar scoliosis surgery, and developed post surgical peri-scar spasms, which were successfully treated by botulinum toxin injections.
Case Description: Two female patients, aged 24 and 31, received injections of 50 UI of XEOMIN, diluted in 1ml and 0.5ml of saline, respectively, following scoliose surgery. Spinal rehabilitation had been performed beforehand. The injected muscles were the rhomboids, and lower trapezius, under ultrasound guidance. Clinical evaluation focused on spams, pain using the numerating rating scale, and functional impact. Informed consent was obtained. No contraindications were present. One month post injection, both patients reported almost complete disappearance of spasms, reduction of pain, improved emotional well-being, and resumption of daily activities. Injections were repeated every four months, with effects gradually waning after two and a half months, accompanied by recurrence of spasms.
Discussions: Post surgical spasms may be related to muscular unbalance, reflex hyperactivity, or irritation of the posterior nerve branches. Few studies specifically target paraspinal spasms, but data on myofascial syndromes or low back pain with paravertebral contractures support the efficacy of botulinum toxin. Its advantages include good tolerability, local administration, a reduction in side effects compared to systemic treatments and prolonged effectiveness.
Conclusions: It represents an interesting local therapeutic option in cases where pharmalogical or rehabilitative approches have failed. Additional studies are needed to validate its systematic integration into the care pathway.
