Background and Aims Life expectancy for adults with spinal muscular atrophy (SMA) has increased significantly and central neuraxial anesthesia remains one of the safest options for this specific category of patients. Patients with SMA have usually been subjected to spine fusion surgeries and suffer from joint contractures and scoliosis. Successful intrathecal access using a traditional posterior approach is often precluded due to spinal deformity. The aim of this case-study is to evaluate the feasibility and safety of the contrast CT-guided transforaminal/interlaminal intrathecal access in patients with spinal muscular atrophy type 2 and 3
Methods 10 adult, non-ambulatory patients with SMA type 2 and 3 were referred for intrathecal administration of Nusinersen. They had undergone extensive thoracolumbar posterior spinal fusion which rendered them without access for a posterior approach. An experienced Anesthesiologist and an Interventional Radiologist identified the shortest needle path from the skin to the neural foramen on imaging. Patients were placed in either the left or right lateral decubitus position with the apex of the scoliotic curvature oriented upwards.
Results 7 patients underwent interlaminal contrast CT-guided intrathecal injections with cutting pencil point needles 20G, without introducer. In 3 patients, the transforaminal approach was used; among them, 1 received the drug through a Tuohy 18G epidural needle.Transient lumbar pain occurred in 2 patients while 1 developed short-term headache.No other complications were noted.
Conclusions Contrast CT-guided intrathecal access is achievable in SMA 2 and 3 patients with challenging spine.The procedure can be easily learned and performed with a high rate of success and low rate of complications.
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