Setting: Tertiary care pediatric hospital. Patient: A 15-year-old boy with spastic quadriplegic cerebral palsy (CP) due to presumed hypoxic ischemic encephalopathy. Case Description: Botulinum toxin type A (BTX-A) was used to treat scoliosis due to spasticity. The patient had levoscoliosis of the thoracolumbar spine from T7 to L3 with its apex at the T12 region. Scoliosis became progressive to the point where the patient had to wear a thoracolumbosacral orthosis at night to prevent arching to the left side and a recommendation of posterior spinal fusion by an orthopedic surgeon was made. On physical examination, his paraspinal muscles from midthoracic to low lumbar area were significantly tight. Total of 300U of BTX-A was injected into the paraspinal muscles of T9-L5 spine in multiple areas under nerve stimulator guidance. Assessment/Results: Patient’s scoliosis improved 22° from 55° to 33° on follow-up spine radiograph at 3 weeks BTX-A injections were given. His sitting and lying postures were also significantly improved where he did not have to wear a thoracolumbosacral orthosis at night anymore. Discussion: Currently, BTX-A injections are accepted practice to treat spasticity in the limbs. This case report is important to address the possible use of BTX-A in scoliosis due to spasticity. Conclusions: BTX-A will be beneficial to prevent further progression of scoliosis due to spasticity.
© 2005 Published by agreement with the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.