Combined Extracorporeal Shock Wave Therapy and Botulinum Toxin Injection for Spasticity in the Acute Phase of Spinal Cord Injury: A Case Report.

Background: No standard treatment has been established for acute-phase spasticity after spinal cord injury (SCI). This case report demonstrates the impact of combining extracorporeal shock wave therapy (ESWT) and botulinum toxin administration on mobilization in the acute phase of SCI-associated spasticity. Case: A man aged in his 50s was admitted to our hospital following a bicycle collision with an automobile. The patient was diagnosed with a non-ossifying cervical SCI without radiographic abnormality. Spasticity in both lower limbs impaired the patient's ability to perform a standing movement and maintain a stable position. Considering the necessity of spasticity management, ESWT and botulinum toxin injection were administered. Discussion: Range of motion (ROM) and Modified Ashworth Scale (MAS) score of the lower limbs, as well as the standing posture, were evaluated. After radical ESWT and botulinum toxin injection, both ROM and MAS improved. The patient gained the ability to maintain a standing position with the assistance of only one person and was able to sit stably without assistance. Conclusions: The administration of ESWT and botulinum toxin injection during the acute care hospital stay for spasticity may be beneficial for promoting early mobilization.