108.
The Effect of Botox Treatment in the Spine Muscles for Cerebral
Paresis Scoliosis
Christian Wong, Søren-Anker Pedersen, Kasper Gosvig, Billy Kristensen, Stig
Sonne-Holm
Department of Orthopaedic Surgery Hvidovre University Hospital;
Department of Paediatrics, Hvidovre University Hospital; Hvidovre University
Hospital, Department of Radiology; Department of Anaesthesiology, Hvidovre
University Hospital; Department of Orthopaedic Surgery, Hvidovre University
Hospital
Background:
Intramuscular injection of Botox has been used off label to
reduce muscle spasticity of the lower and upper extremities in cerebral paresis
(
CP) with only a few prospective, randomized double-blinded studies
documenting the effect - especially in the CP spine, where only one study has
been published.
Purpose / Aim of Study:
We wanted to examine the effects of intramuscular
injection of Botox in the CP scoliotic spine in a prospective, randomized triple-
blinded cross-over design using NaCl and Botox.
Materials and Methods:
10
CP children using a brace for scoliosis met the
inclusion criteria and were injected in the M. Iliopsoas, M. Quadratus
Lumborum and M. Erector Spinae with either NaCl or Botox targeted by
ultrasonic guidance every 6 months. Standardized relaxed and lateral-flexion
X-rays of the spine were performed before and 6 weeks after for every
injection. Changes in Cobb's angle and Nash and Moe's classification were
evaluated by 3 experienced doctors separately and together; a change in
Cobb’s angle of both 5 and 10 degrees was cut-off level of effect. Clinical
results were evaluated by the pediatric quality of life (PQL) score and open
questioning of the parents about the child's wellbeing. One serious adverse, but
unrelated event of pneumonia resulting in death was recorded.
Findings / Results:
Using both cut-off levels 2 test subjects had positive
radiological outcome in Cobb's angle of botox treatment and 8 had negative or
no effect of treatment. 8 out of 10 parents of the children indicated better
stability in standing or when sitting in a wheel chair and 2 indicated no change.
No changes in PQL were detected.
Conclusions:
In spite of positive subjective clinical evaluation by parents
radiological outcomes and results from questionnaires showed no effect of the
treatment. Based on these findings treatment cannot be recommended.
