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Transforaminal Approach in SMA Patients: Cause of Nerve Injury or Treatment Option? A Case Report
Ronay Bozyel Aksin1, Savas Sencan1, Erhan Biyikli2
1Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Istanbul, Türkiye.
Background:
Administering intrathecal nusinersen to patients with spinal muscular atrophy (SMA) is commonly done under fluoroscopic guidance, and the use of the transforaminal intrathecal route has also been reported to be successful without major complications. However, this case report presents a patient who developed radicular neuritis following a transforaminal administration of nusinersen.
Case Report:
A 28-year-old patient with SMA type 2 and severe scoliosis experienced persistent back and leg pain after a transforaminal intrathecal injection. Lumbar magnetic resonance imaging revealed contrast enhancement of the left L4 nerve root, suggesting neuritis. Despite medical treatment, the patient's symptoms did not improve significantly. As an alternative, a transforaminal epidural steroid injection, a method used commonly for radicular pain, was administered. After the procedure, the patient's pain was markedly alleviated.
Conclusion:
This case highlights the diagnosis and management of a rare iatrogenic complication associated with transforaminal access and emphasizes transforaminal epidural steroid injection as a potential treatment option in similar clinical scenarios.
