Authors : Aneesh Mohimen, Aneesh Mohimen, Ravi Anadure, Ravi Anadure, Jitesh Goel, Jitesh Goel, Samaresh Sahu, Samaresh Sahu
DOI : 10.18231/j.ijn.2020.008
Volume : 6
Issue : 1
Year : 2020
Page No : 41-45
Introduction: We describe the short term and intermediate efficacy of direct intra-muscular injection of
Botulinum toxin in Pyriformis Syndrome, along with its safety profile.
Materials and Methods: A diagnosis of pyriformis syndrome was made by exclusion, only after careful
clinical assessment & MR Imaging. Patients were selected for Botox infiltration if adequate symptom relief
was not noted after conservative management. Patients were placed prone on the CT table with a pillow
placed under the lower pelvis for elevation of the hip joints. Subsequently a total of 03 spinal needles (22 G)
were placed in the pyriformis muscle belly, at a distance of 1 to 1.5 cm apart. Finally, freshly reconstituted
50U of Botox was injected through each of the needles into the muscle belly (total dose of 150 U).
Results: A total of 26 procedures were performed on 25 patients (15 male, 10 female) with one patient
receiving a second procedure 15 months after the initial treatment. The mean age of the patient population
was 48.6 years. 88.5% (23/26) patients reported very good pain relief when assessed on a Visual analogue
scale (VAS) at 3 months, which was sustained at 6 months in 77% (20/26) patients. No procedure related
complications were noted.
Conclusion: CT guided Botox infiltration into the pyriformis is a safe and effective modality for pain relief
in pyriformis syndrome. Three needle technique with infiltration across the length of the muscle appears
be more effective in symptom alleviation, as compared to the conventional single site injection.
Keywords: Botox, Pyriformis.