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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

  • Clinical Institute of Radiology, University Medical Centre LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Salapura, Vladka
, 
Ziga Snoj

Ziga Snoj

  • Clinical Institute of Radiology, University Medical Centre LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Snoj, Ziga
, 
Lea Leonardis

Lea Leonardis

  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
  • Institute of Clinical Neurophysiology, University Medical Centre LjubljanaLjubljana, Slovenia
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Leonardis, Lea
, 
Blaz Koritnik

Blaz Koritnik

  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
  • Institute of Clinical Neurophysiology, University Medical Centre LjubljanaLjubljana, Slovenia
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Koritnik, Blaz
 oraz 
Viktorija Kostadinova

Viktorija Kostadinova

Clinical Institute of Radiology, University Medical Centre LjubljanaLjubljana, Slovenia
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Kostadinova, Viktorija
  
14 sie 2022
Cone-beam computed tomography guided nusinersen administrations in adult spinal muscular atrophy patients with challenging access: a single- center experience's Cover Image
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Kategoria artykułu: research article
Data publikacji: 14 sie 2022
Zakres stron: 319 - 325
Otrzymano: 19 kwi 2022
Przyjęty: 12 cze 2022
DOI: https://doi.org/10.2478/raon-2022-0033
Słowa kluczowe
© 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
Język:
Angielski
Częstotliwość wydawania:
4 razy w roku
Dziedziny czasopisma:
Medycyna, Medycyna kliniczna, Medycyna wewnętrzna, Hematologia, onkologia, Radiologia
Kanał RSS czasopisma