Resident Mount Sinai New York, New York, United States
Case Diagnosis: A 26-year-old female with a C2 ASIA A spinal cord injury after a fall who developed chronic hypertonicity of her bilateral hip flexors making it difficult for her to sit in her wheelchair.
Case Description: The patient had an approximate hip flexor angle of 100 degrees preventing her from sitting in her wheelchair. She had received previous neurotoxin injections to the lower extremities in the past with the most recent injections 1 week prior (50 units of Xeomin to each of the left and right iliopsoas muscles using ultrasound guidance). Despite neurotoxin and physical therapy, the patient continued to have spasticity of her hip flexors preventing her from sitting in her wheelchair. Phenol was then injected to her iliopsoas muscles (2cc to the Left iliopsoas and 1cc to the Right iliopsoas) using ultrasound and electrical stimulation guidance. There was immediate improvement in her spasticity, resulting in an approximate resting hip flexor angle of 80 degrees and allowing her to sit in her wheelchair.
Discussions: Phenol injections can provide rapid improvement in spasticity for patients with spinal cord injury through chemical destruction of the nerve through denaturing of proteins, thus interfering with nerve conduction. Ultrasound and electrical stimulation are often used to locate the nerve. In this case, the patient showed immediate improvement of hip flexor tone after phenol neurolysis to the iliopsoas muscles allowing her to sit in her wheelchair.
Conclusions: To my knowledge, p<span style="background: white;">henol neurolysis to the iliopsoas muscle for hip flexor spasticity has not been studied in tetraplegia patients. This brings up the question of what is the recommended dose of phenol for the iliopsoas muscle in conjunction with Xeomin injections. Phenol denervation of the iliopsoas muscle can be considered for rapid improvement of spasticity in patients with severe hip flexor tone despite recent neurotoxin administration in patients with spinal cord injury.
