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There are limited studies for botulinum toxin A injections for piriformis syndrome

Further detailed subgroup analyses were conducted with isatuximab in patients with renal impairment, soft-tissue plasmacytomas, and gain(1q21), potentially leading to evidence-based use in patients with these characteristics

These include: Large disc extrusions or sequestered fragments requiring surgical intervention Severe spinal stenosis with significant canal narrowing Bone spurs (osteophytes) compressing nerve structures Advanced degenerative disc disease with complete disc height loss Spondylolisthesis (vertebral slippage) beyond grade 1 Cauda equina syndrome (medical emergency requiring immediate surgery) Users with these conditions typically report minimal improvement from peptide therapy alone