Ann Rehabil Med.  2020 Oct;44(5):370-377. 10.5535/arm.19211.

Accuracy of Ultrasound-Guided and Non-guided Botulinum Toxin Injection Into Neck Muscles Involved in Cervical Dystonia: A Cadaveric Study

• Ko YD
• Yun SI
• Ryoo D
• Chung ME
• Park J

• KMID: 2508462
• DOI: http://doi.org/10.5535/arm.19211

Abstract

Objective
To compare the accuracy of ultrasound-guided and non-guided botulinum toxin injections into the neck muscles involved in cervical dystonia.
Methods
Two physicians examined six muscles (sternocleidomastoid, upper trapezius, levator scapulae, splenius capitis, scalenus anterior, and scalenus medius) from six fresh cadavers. Each physician injected ultrasound-guided and non-guided injections to each side of the cadaver’s neck muscles, respectively. Each physician then dissected the other physician’s injected muscle to identify the injection results. For each injection technique, different colored dyes were used. Dissection was performed to identify the results of the injections. The muscles were divided into two groups based on the difficulty of access: sternocleidomastoid and upper trapezius muscles (group A) and the levator scapulae, splenius capitis, scalenus anterior, and scalenus medius muscles (group B).
Results
The ultrasound-guided and non-guided injection accuracies of the group B muscles were 95.8% and 54.2%, respectively (p<0.001), while the ultrasound-guided and non-guided injection accuracies of the group A muscles were 100% and 79.2%, respectively (p<0.05).
Conclusion
Ultrasound-guided botulinum toxin injections into inaccessible neck muscles provide a higher degree of accuracy than non-guided injections. It may also be desirable to consider performing ultrasound-guided injections into accessible neck muscles.

Keyword

Cervical dystonia; Ultrasonography; Botulinum toxins

Figure

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  Fig. 1. Ultrasound-guided injection into the scalenus anterior (SA) muscle. Intramuscular needle (arrow) is visible in this figure. SCM, sternocleidomastoid; BP, brachial plexus; SM, scalenus medius.

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  Fig. 2. Dissected cadaver with ultrasound-guided injection (blue and green dye, arrow) and non-guided injection (orange and purple dye, arrow head). The purple dye that targeted the scalenus medius muscle was misinjected into the scalenus posterior muscle. SA, scalene anterior; BP, brachial plexus; SM, scalene medius; SP, scalene posterior.

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