CT-guided Lumbar Puncture for Intrathecal Nusinersen Injection in Patients with Spinal Muscular Atrophy: Technical...

Area of Science:

• Neurology
• Radiology
• Medical Interventions

Background:

• Spinal muscular atrophy (SMA) is a rare neuromuscular disorder.
• Intrathecal nusinersen is a key treatment for SMA.
• Challenging lumbar punctures can occur in patients with complex spinal anatomy or instrumentation.

Purpose of the Study:

• To evaluate the feasibility of CT-guided nusinersen administration in SMA patients.
• To assess the safety and radiation exposure associated with this technique.
• To compare outcomes in different patient subgroups.

Main Methods:

• Retrospective analysis of 458 CT-guided nusinersen injections in 44 SMA patients.
• Evaluation of technical success, complications, procedure times, and radiation exposure.
• Procedures performed in various positions (prone, lateral, oblique) based on patient anatomy.

Main Results:

• High technical success rate of 98.3% (449/458).
• Low complication rate of 1.1% (5/458), including transient pain and hematomas.
• Dorsal spondylodesis was associated with increased procedure duration and radiation exposure (effective dose 2.22 vs. 1.74 mSv).

Conclusions:

• CT-guided lumbar puncture is a safe and effective method for intrathecal nusinersen delivery in SMA patients, including those with complex spinal conditions.
• Dorsal spondylodesis presents increased procedural complexity.
• Optimized techniques and positioning are crucial for success and minimizing radiation; further studies comparing CT and fluoroscopy are warranted.