Retrospective analysis comparing proximal injection of the iliopsoas muscle versus sonography-guided distal injection (SIMPLE)

Introduction: Purpose of this analysis was to compare two different approaches for sonography guided injection of Botulinum-Toxin into Iliopsoas muscle. The acronym SIMPLE stands for “Sonography guided Injection of BTA in Multi-level treatment including injecting the IlioPsoas distaLly under analgosEdation“.

Patients and Methods: Retrospective analysis of 85 patients receiving 129 treatment sessions including iliopsoas muscle. Patients were divided into two groups. Group A had been treated in general anaesthesia with proximal injection versus analgo-sedation in group B injected distally respectively. Data analysis included the patients’ diagnosis, the Gross Motor Function Classification System (GMFCS), functional efficacy (Goal Attainment Scaling), and tolerability/side effects of the procedure.

Results: The injection of Botulinum-Toxin in analgo-sedation in patients with spastic hip flexion shows equal efficacy compared to general anaesthesia with a slight better outcome in group B (GAS-score –2: 30% in group A vs. 13% in group B, -1: 22% vs. 22%, 0: 37% vs. 57%, +1: 4% vs. 7%, +2: 0% vs. 2%).

Side effects occurred in 22% of group A vs. 20,9% in group B. Most reported SE was focal weakness. No intolerable side effects were registered. Shorter injection-intervals in group B (4.56 month) vs. group A (8 months) were assigned to the improve of practicability of the SIMPLE-treatment strategy.

Conclusion: SIMPLE-treatment strategy demonstrates to simplify and optimize the injection procedure and thus facilitates appropriate multi-level-treatment with Botulinum Toxin.

Keywords: SIMPLE, cerebral palsy, children