AB273. SOH26AB_0116. Concomitant caudal epidural and lumbar paravertebral botulinum toxin: a case report

Background: Little is known regarding concomitant caudal epidural and lumbar paravertebral botulinum toxin.

Case Description: We present the case of a 60-year-old female with a lumbar disc bulge at L5–S1. She got a short-term benefit with a caudal epidural (6 weeks). The patient underwent ultrasound-guided caudal epidural injection (triamcinolone and saline 10 mL). She also had a paravertebral lumbar botulinum toxin injection of 200 IU. Both sides and two injection sites on each side in the multifidus muscle. The procedure was performed in a theatre setting. Lumbar paravertebral muscle spasm is common in lumbar spine conditions. Caudal epidural is used to treat pain originating from lumbar disc protrusions. Botulinum toxin has been used to treat back pain associated with paravertebral muscle spasm. Lumbar paravertebral Botulinum toxin has not been reported to be used concomitantly with other spinal pain interventions. Ultrasound-guided targeted injections involve using imaging to guide the precise placement of a needle for injection. It allows the healthcare provider to visualize the target area in real time. A sustained analgesic effect was reported when followed up at 3 months. Functional outcomes, including range of motion and daily activities improved substantially. No complications were reported.

Conclusions: Lumbar paravertebral Botulinum toxin has not been reported to be used concomitantly with other spinal pain interventions. In this case, it provided longer-term persistent pain relief. In our patient’s case, it was an effective pain-relieving therapy, but more studies are needed to evaluate its efficacy.

Keywords: Caudal epidural; concomitant analgesic methods; ultrasound-guided; lumbar botulinum toxin; case report