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The Complex Spine in Children with Spinal Muscular Atrophy: The Transforaminal Approach-A Transformative Technique.

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Summary
This summary is machine-generated.

Spinal muscular atrophy patients undergoing nusinersen injections are classified by spine complexity. Simple spines need no imaging, while complex spines require preprocedural imaging for safe intrathecal access.

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Area of Science:

  • Neurology
  • Pediatrics
  • Genetics

Background:

  • Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder impacting motor function.
  • Spinal stabilization may be required due to disease progression or scoliosis.
  • Intrathecal nusinersen administration necessitates careful consideration of spinal anatomy.

Purpose of the Study:

  • To present experience with transforaminal intrathecal nusinersen injections in SMA patients.
  • To subdivide SMA patients into simple and complex spinal anatomy subgroups for procedural planning.
  • To establish a protocol-driven approach for nusinersen delivery based on spinal complexity.

Main Methods:

  • Retrospective review of 31 SMA patients (types 1-3) receiving intrathecal nusinersen.
  • Classification of patients into simple or complex spinal anatomy subgroups.
  • Analysis of procedural approaches, including transforaminal and cervical routes, for complex spines.

Main Results:

  • 164 intrathecal nusinersen injections performed with 100% technical success.
  • Nine patients with complex spines underwent 45 injections; 42 via transforaminal approach.
  • No complications were reported in any of the procedures.

Conclusions:

  • A protocol-driven approach based on spinal anatomy is effective for SMA patients.
  • Simple spines do not require preprocedural imaging for nusinersen injections.
  • Complex spines necessitate preprocedural imaging and guidance, favoring the transforaminal approach.