Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Muscle Nerve. 2022 May;65(5):585-589. doi: 10.1002/mus.27518. Epub 2022 Feb 23.
INTRODUCTION/AIMS: Previous papers on ultrasound (US)-guided delivery of nusinersen in patients with spinal muscle atrophy (SMA) described good results with translaminar approach. However, this approach is not possible in patients with spinal fusion and no visible interlaminar space on pre-procedural computed tomography (CT). US-guided transforaminal nusinersen delivery is a potential option that warrants investigation.
Twenty adult SMA patients with challenging access were treated in our institution under cone beam CT (CBCT) guidance. The patients were already in the maintenance phase of the dosing protocol and were prospectively evaluated for US-guided transforaminal approach. After they completed one injection via US-guided transforaminal approach, success and safety of the approach were analyzed. Patients shared their experience on US-guided in comparison to CBCT-guided injections.
US-guided transforaminal puncture was possible in 14 (70.0%) patients, although 2 of them required needle repositioning under fluoroscopy due to inadvertent access of a prominent vein. US-guided transforaminal approach was therefore successful in 60% of patients. Mild adverse events were recorded in four patients. The survey on patients' experience showed that seven reported no difference in the two approaches, six preferred the US-guided procedure, and one preferred the CBCT-guided procedure.
US-guided transforaminal lumbar approach is an effective and safe method of intrathecal nusinersen delivery in adult SMA patients with challenging spinal access and could be considered the first option in appropriately selected adult SMA patients requiring transforaminal nusinersen delivery.
介绍/目的：以前关于超声（US）引导下将 nusinersen 递送至脊髓性肌萎缩症（SMA）患者的论文描述了经皮穿刺入路的良好结果。然而，对于脊柱融合且术前计算机断层扫描（CT）无可见的椎板间隙的患者，这种方法是不可能的。超声引导下经椎间孔 nusinersen 递送是一种有潜力的选择，值得进一步研究。
在我院，20 名具有挑战性的经皮穿刺入路的成年 SMA 患者在锥形束 CT（CBCT）引导下接受治疗。这些患者已经处于剂量方案的维持阶段，并前瞻性地评估了超声引导下经椎间孔入路的情况。在他们通过超声引导下经椎间孔入路完成一次注射后，分析了该入路的成功性和安全性。患者分享了他们对超声引导与 CBCT 引导注射的经验。
尽管有 2 例因误穿突出的静脉而需要在透视下重新定位，但 14 例（70.0%）患者能够进行超声引导下经椎间孔穿刺。因此，超声引导下经椎间孔入路在 60%的患者中获得成功。4 例患者记录了轻度不良事件。对患者经验的调查显示，7 例患者报告两种方法无差异，6 例患者更喜欢超声引导程序，1 例患者更喜欢 CBCT 引导程序。
超声引导下经椎间孔腰椎入路是一种在具有挑战性的脊柱入路的成年 SMA 患者中进行鞘内 nusinersen 递送的有效且安全的方法，可以被认为是在适当选择的需要经椎间孔 nusinersen 递送的成年 SMA 患者中首选的方法。
