Ultrasound-guided Botulinum Toxin injection into the rectus abdominis muscle for intractable abdominal spasms in spinal cord injury: A case report

CONTEXT: Abdominal spasms following spinal cord injury (SCI) can be a source of severe pain and functional impairment, often proving resistant to systemic antispastic medications. While botulinum toxin A (BoNT-A) is widely used for limb spasticity, its application for abdominal wall spasms in SCI is documented infrequently. FINDINGS: We present the case of a 43-year-old male with C4 AIS-C tetraplegia suffering from severe, painful spasms of the rectus abdominis (RA) muscle, which were refractory to high-dose oral baclofen. Due to the localized nature of the symptoms and the risks associated with intrathecal baclofen, ultrasound-guided BoNT-A was administered specifically to the RA muscle. The intervention resulted in a significant reduction in spasm frequency and severity (Penn Spasm Scale), improved sitting comfort, and enhanced quality of life. CONCLUSION: This case suggests that targeted RA injection may represent a safe and sustainable alternative for selected SCI patients with focal abdominal spasticity.