Ko Diana, Blatt Daniel, Karam Chafic, Gupta Kunal, Raslan Ahmed M
1School of Medicine; and.
Departments of2Neurology and.
J Neurosurg Spine. 2019 Apr 19;31(2):217-221. doi: 10.3171/2019.2.SPINE181366. Print 2019 Aug 1.
Nusinersen (Spinraza) is a US Food and Drug Administration-approved intrathecal medication for the treatment of spinal muscular atrophy (SMA). Adult patients with SMA often undergo thoracolumbar fusion to treat neurogenic scoliosis, preventing thecal access. The authors report a laminotomy technique and the ease of intrathecal access in three SMA patients with prior thoracolumbar fusions.Patients were positioned in the lateral decubitus position or prone. Lumbar laminotomy was performed below the conus, between the lateral longitudinal rods, to preserve mechanical stability. Fluoroscopy provided real-time identification of instruments. Hardware was contoured with a carbide drill bit to develop the surgical window. Fiducial screws were placed along the perimeter for demarcation. Sublaminar wire removal caused dural defects that were repaired with a layer of dural substitute onlay and sealant. All patients successfully received nusinersen thecal injections via lumbar puncture by an interventional radiologist. Fluoroscopy time ranged from 6 to 36 seconds. No postoperative pseudomeningoceles, cerebrospinal fluid leaks, or wound complications occurred.For patients with SMA and posterior fusion from prior scoliosis treatment, lumbar laminotomy is an effective method for creating thecal access for the administration of nusinersen.
诺西那生钠（Spinraza）是一种经美国食品药品监督管理局批准的鞘内注射药物，用于治疗脊髓性肌萎缩症（SMA）。患有SMA的成年患者常接受胸腰椎融合术来治疗神经源性脊柱侧弯，这会阻碍鞘内注射给药。作者报告了一种椎板切开术技术以及在3例曾接受胸腰椎融合术的SMA患者中进行鞘内注射给药的简便方法。患者取侧卧位或俯卧位。在圆锥下方、外侧纵杆之间进行腰椎椎板切开术，以保持机械稳定性。透视可实时识别器械位置。用硬质合金钻头对硬件进行塑形以形成手术窗口。沿周边放置基准螺钉用于标记。去除椎板下钢丝导致硬脊膜缺损，用一层硬脊膜替代物覆盖并使用密封剂进行修复。所有患者均由介入放射科医生通过腰椎穿刺成功接受诺西那生钠鞘内注射。透视时间为6至36秒。术后未发生假性脑脊膜膨出、脑脊液漏或伤口并发症。对于患有SMA且因先前脊柱侧弯治疗而进行了后路融合术的患者，腰椎椎板切开术是一种为注射诺西那生钠建立鞘内给药通道的有效方法。
