From the Department of Radiology, Neuroradiology Section, Loma Linda University Medical Center, Loma Linda, California.
AJNR Am J Neuroradiol. 2020 Jan;41(1):183-188. doi: 10.3174/ajnr.A6351. Epub 2019 Dec 12.
Patients with spinal muscular atrophy often have complete interlaminar osseous fusion, precluding lumbar puncture via the standard interlaminar approach. Recently, we have developed a new coaxial curved-needle variation of fluoroscopy-guided transforaminal lumbar puncture for intrathecal injections in this patient population. Between October 2017 and November 2018, fifty-nine consecutive transforaminal lumbar punctures using this technique were performed in 12 patients with spinal muscular atrophy for intrathecal nusinersen injection, with a 100% technical success rate and no C1-2 punctures required. One major complication occurred, consisting of a post-dural puncture headache, which required a therapeutic transforaminal epidural blood patch. Two minor complications occurred, both of which involved inadvertent puncture of a dorsal muscular arterial branch, without clinical sequelae. A fluoroscopy-guided curved-needle transforaminal approach is an effective technique for lumbar puncture in difficult cases, such as in this cohort of patients with spinal muscular atrophy and complete interlaminar osseous fusion undergoing intrathecal nusinersen injections.
脊髓性肌萎缩症患者常有完全的椎板间骨性融合，使得通过标准的椎板间入路进行腰椎穿刺成为不可能。最近，我们开发了一种新的同轴弯针式透视引导下经椎间孔腰椎穿刺技术，用于该患者群体的鞘内注射。2017 年 10 月至 2018 年 11 月，12 例脊髓性肌萎缩症患者共进行了 59 例经此技术的经椎间孔腰椎穿刺，用于鞘内注射 nusinersen，技术成功率为 100%，无需进行 C1-2 穿刺。发生 1 例主要并发症，为硬脊膜穿刺后头痛，需要进行治疗性经椎间孔硬膜外血贴。发生 2 例轻微并发症，均为无意中刺破背侧肌动脉分支，无临床后遗症。透视引导下弯针经椎间孔入路是一种有效的腰椎穿刺技术，适用于困难病例，如本队列中的脊髓性肌萎缩症和完全椎板间骨性融合患者，行鞘内 nusinersen 注射。
