Ultrasound-guided botulinum toxin injections for abdominal spasticity and dyspnea in an ambulatory patient with an incomplete cervical spinal cord injury: a case report.

Authors

Maarten M J W van Herpen, Alexander C Geurts, Ilse J W van Nes

Published in

Journal of medical case reports. Jul 03, 2026. Epub Jul 03, 2026.

Abstract

Abdominal spasticity in spinal cord injury (SCI) patients may remain unrecognized, despite its impact on quality of life.
We report a 47-year-old white Dutch man with incomplete C4 SCI (AIS D) presenting with dyspnea, abdominal pain, and discomfort from involuntary abdominal muscle contractions. Five year post-injury, the patient developed bloating and pronounced abdominal pain, pain in the lower back, and in the intercostal muscles. In addition, a 7-cm diastasis developed in the abdominal midline. These complaints reduced ambulatory capacity and quality of life. Initial management with systemic antispasticity treatment (tolperisone 50 mg, 3×/day) relieved leg spasticity and closed the diastasis, yet failed to alleviate dyspnea. Ultrasound imaging confirmed spasticity predominantly in the internal oblique and transverse abdominal muscles. Given the persistence of abdominal spasticity complaints, we initiated a series of ultrasound-guided botulinum toxin (100-150E incobotulinum toxin-A) injections to the internal and external oblique muscles-with one session also targeting transversus. The injection protocol was refined over successive treatments to achieve an optimal distribution while minimizing side effects on core stability. Although the patient experienced transient balance issues and lower back pain during the initial adjustment period, these effects were minor and resolved within 2-3 weeks.
This case underscores that in ambulatory SCI patients, systemic treatments alone may not sufficiently address abdominal spasticity and concomitant symptoms like dyspnea. Low-dose ultrasound-guided botulinum toxin injections targeting the abdominal muscles can provide significant symptom relief and improve overall functional capacity, offering a safe and effective addition to low-dose systemic treatment.

PMID:
42400067
Bibliographic data and abstract were imported from PubMed on 04 Jul 2026.

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