Ultrasound-guided lumbar puncture for nusinersen administration in spinal muscular atrophy patients
Abstract
Background and purpose
The purpose was to report the results of ultrasound-guided lumbar puncture for the administration of nusinersen in spinal muscular atrophy (SMA) patients with complex spines.
Methods
Eighteen SMA patients (five children, five adolescents and eight adults) with either severe scoliosis or spondylodesis were evaluated for ultrasound-guided lumbar puncture. Ultrasound was performed with a 3.5 MHz transducer to guide a 22 gauge × 15 mm needle, which was placed in the posterior lumbar space following a parasagittal interlaminar approach.
Results
Twelve patients had undergone spinal instrumentation (nine growing rods and three spinal fusion) whilst the other six showed severe scoliosis. Success was achieved in 91/94 attempts (96.8%), in 14/18 patients (77.8%), including 100% of children and adolescents and 50% of adult patients. In two of the unsuccessfully treated patients, computed tomography and fluoroscopy-guided transforaminal lumbar punctures were also tried without success. After a median follow-up of 14 months, only few adverse events, mostly mild, were observed.
Conclusion
The ultrasound-guided lumbar puncture, following an interlaminar parasagittal approach, is a safe and effective approach for intrathecal treatment with nusinersen in children, adolescents and carefully selected adult SMA patients with complex spines and could be considered the first option in them.
Disclosure of conflicts of interest
Dr Veiga-Canuto reports no disclosures. Dr Cifrián-Pérez reports no disclosures. Dr Pitarch-Castellano served on advisory boards for Avexis and Biogen and received travel and speaker honoraria from Biogen and Roche. Dr Vázquez-Costa is funded by a grant of the Instituto de Salud Carlos III (JR19/00030, PI Vázquez), served on advisory boards for Biogen and Roche and received travel and speaker honoraria from Biogen and Roche. Dr Aparici reports no disclosures.
Open Research
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
