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Cone-beam computed tomography guided nusinersen administrations in adult spinal muscular atrophy patients with challenging access: a single- center experience

Vladka Salapura
Vladka Salapura
, 
Ziga Snoj
Ziga Snoj
, 
Lea Leonardis
Lea Leonardis
, 
Blaz Koritnik
Blaz Koritnik
 e 
Viktorija Kostadinova
Viktorija Kostadinova
   | 14 ago 2022
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Article Category: research article
Pubblicato online: 14 ago 2022
Pagine: 319 - 325
Ricevuto: 19 apr 2022
Accettato: 12 giu 2022
DOI: https://doi.org/10.2478/raon-2022-0033
© 2022 Vladka Salapura, Ziga Snoj, Lea Leonardis, Blaz Koritnik, Viktorija Kostadinova, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Cone-beam CT orthogonal reconstructions demonstrating the planned needle trajectory. (A), (B). Planning the interlaminar approach (yellow arrows); (C), (D). Planning the transforaminal approach (yellow arrows).
Cone-beam CT orthogonal reconstructions demonstrating the planned needle trajectory. (A), (B). Planning the interlaminar approach (yellow arrows); (C), (D). Planning the transforaminal approach (yellow arrows).

Figure 2

(A). A 22-year-old female with severe scoliotic deformity of the spine; (B). The nusinersen administration was performed with interlaminar approach under cone-beam CT -guidance; (C). Introduction of the needle following the planned trajectory (white dotted line) to the target point (white circle).
(A). A 22-year-old female with severe scoliotic deformity of the spine; (B). The nusinersen administration was performed with interlaminar approach under cone-beam CT -guidance; (C). Introduction of the needle following the planned trajectory (white dotted line) to the target point (white circle).

Figure 3

(A). A 42-year old female after corrective surgery for scoliosis; (B). Transforaminal approach planning before needle introduction (yellow arrow); (C). Introduction of the needle following the planned trajectory (white dotted line) to the target position (white circle).
(A). A 42-year old female after corrective surgery for scoliosis; (B). Transforaminal approach planning before needle introduction (yellow arrow); (C). Introduction of the needle following the planned trajectory (white dotted line) to the target position (white circle).

Figure 4

Scatter plot presenting effective dose for each cone-beam CT-guided procedure (blue dots) and calculated average trend line with orange dots for every ten procedures. mSv = milli severt
Scatter plot presenting effective dose for each cone-beam CT-guided procedure (blue dots) and calculated average trend line with orange dots for every ten procedures. mSv = milli severt

Adverse events for cone-beam CT (CBCT)-guided intrathecal nusinersen delivery patients and classical lumbar puncture patients

CBCT- guided (n = 108) Conventional lumbar (n = 112) P-value
Headache occurence (%) 18 (17) 42 (37)
Headaches (range) VAS, median 2 (0–10) 4.5 (0–10) 0.12
Headaches median (range) duration day, 0.05 (0–5) 2 (0–6) 0.05
Low back pain occurrence (%) 11 (10) 40 (36)
Low (range) back pain VAS, median 0 (0–2) 2.75 (6) < 0.01
Low median back (range) pain duration day, 0 (0–4) 2.45 (0–14) < 0.01

Patient characteristics for cone-beam CT (CBCT)-guided intrathecal nusinersen delivery patients and classical lumbar puncture patients

CBCT-guided Classical lumbar P-value
Male sex (%) 10 (50) 12 (67)
Age median at first (range) administration, year 33.5 (20–62) 44.5 (19–69) 0.62
BMI, median (range) kg/m2 23.4 (14.2–41.8) 24.7 (14.3–33.6) 0.08
SMA type 2 (%) 13 (65) 0
SMA type 3 (%) 7 (35) 15 (83)
SMA type 4 (%) 0 3 (17)
Posterior fusion instrumentation scoliosis (%) due to 10 (50) 0
Severe scoliosis (%) 17 (85) N/A

Procedure summary

Interlaminar Transforaminal Total
L1-L2 (%) 0 (0) 4 (4) 4 (4)
L2-L3 (%) 7 (6) 48 (44) 55 (50)
L3-L4 (%) 10 (9) 35 (32) 45 (41)
L4-L5 (%) 2 (2) 3 (3) 4 (5)
Number of procedures (%) 19 (18) 89 (82) 108 (100)
Duration mean ± SD per min procedure, 63 ± 21 60 ± 26 62 ± 25
eISSN:
1581-3207
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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