From the Department of Radiology (D.R.N., C.O., A.M.M., J.B.R.), Neuroradiology Section, University of Minnesota, Minneapolis, Minnesota.
From the Department of Radiology (D.R.N., C.O., A.M.M., J.B.R.), Neuroradiology Section, University of Minnesota, Minneapolis, Minnesota
AJNR Am J Neuroradiol. 2018 May;39(5):986-991. doi: 10.3174/ajnr.A5596. Epub 2018 Mar 22.
Interlaminar lumbar puncture and cervical puncture may not be ideal in all circumstances. Recently, we have used a transforaminal approach in selected situations. Between May 2016 and December 2017, twenty-six transforaminal lumbar punctures were performed in 9 patients (25 CT-guided, 1 fluoroscopy-guided). Seven had spinal muscular atrophy and were referred for intrathecal nusinersen administration. In 2, CT myelography was performed via transforaminal lumbar puncture. The lumbar posterior elements were completely fused in 8, and there was an overlying abscess in 1. The L1-2 level was used in 2; the L2-3 level, in 10; the L3-4 level, in 12; and the L4-5 level, in 2 procedures. Post-lumbar puncture headache was observed on 4 occasions, which resolved without blood patching. One patient felt heat and pain at the injection site that resolved spontaneously within hours. One patient had radicular pain that resolved with conservative treatment. Transforaminal lumbar puncture may become an effective alternative to classic interlaminar lumbar puncture or cervical puncture.
经椎间孔腰椎穿刺和颈椎穿刺在某些情况下可能并不理想。最近，我们在一些特定情况下使用了经椎间孔入路。在 2016 年 5 月至 2017 年 12 月期间，9 名患者（25 例 CT 引导，1 例透视引导）进行了 26 例经椎间孔腰椎穿刺。7 例患有脊髓性肌萎缩症，被转介进行鞘内注射 nusinersen。2 例行经椎间孔腰椎穿刺 CT 脊髓造影。8 例腰椎后元素完全融合，1 例有上方脓肿。2 例使用 L1-2 水平，10 例使用 L2-3 水平，12 例使用 L3-4 水平，2 例使用 L4-5 水平。4 次出现腰椎穿刺后头痛，未经血液贴补即缓解。1 例患者在注射部位感到发热和疼痛，数小时内自行缓解。1 例患者出现神经根痛，经保守治疗缓解。经椎间孔腰椎穿刺可能成为经典的经椎间孔腰椎穿刺或颈椎穿刺的有效替代方法。
