Objective: To assess the accuracy of anatomy-guided BoNT injections in cervical muscles.

Background: Botulinum neurotoxin (BoNT) is the first line therapy for cervical dystonia; some patients are however bad responders. Several factors may influence the response to this treatment, such as the age, the presence of head tremor, the predominant component of the dystonia or the quality of muscle selection. The accuracy of needle placement may also play a part.

Method: Consecutive patients receiving anatomy-guided (i.e. visual and palpatory) cervical injections of BoNT were included in the study. After the needle was inserted in a target muscle, an ultrasound machine was used to localize the needle tip and the BoNT pool. The injections were performed by a four physicians from the same department, each with a more than 10 years’ experience in BoNT injections.

Results: Fifty three patients were included (17 men, 36 women; mean age 61.8+/-12.8 years). BoNT was injected in 252 muscles (Splenius capitis = 74; Semispinalis capitis = 11; Semispinalis cervicis = 1; Trapezius = 49; Levator Scapulae = 54; Sternocleidomastoideus = 60; Scalenus medius = 3). The mean number of injections by muscle was 1.3. Among the 320 injection sites, 244 (76.0%) were considered as accurate, 36 (12.1%) too superficial, 28 (8.7%) too deep; the accuracy of 13 injections (4.1%) remained unclear. The accuracy was especially low in the Splenius capitis (67.0%).

Conclusion: Even into the hands of trained physicians, clinical guidance of BoNT injections in cervical muscles is often inaccurate. This emphasizes the importance of imaging-guided injection protocols.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/anatomy-guided-injections-of-botulinum-neurotoxin-in-neck-muscles-how-accurate-is-needle-placement/