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

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

Radiology and Oncology
Volume 56 (2022): Issue 3 (September 2022)
By: Vladka Salapura,  Ziga Snoj,  Lea Leonardis,  Blaz Koritnik and  Viktorija Kostadinova  
Open Access
|Aug 2022

Figures & Tables

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, median2 (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, median0 (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-guidedClassical lumbarP-value
Male sex (%)10 (50)12 (67)
Age median at first (range) administration, year33.5 (20–62)44.5 (19–69)0.62
BMI, median (range) kg/m223.4 (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 (%)03 (17)
Posterior fusion instrumentation scoliosis (%) due to10 (50)0
Severe scoliosis (%)17 (85)N/A

Procedure summary

InterlaminarTransforaminalTotal
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 ± 2160 ± 2662 ± 25
DOI: https://doi.org/10.2478/raon-2022-0033 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 319 - 325
Submitted on: Apr 19, 2022
Accepted on: Jun 12, 2022
Published on: Aug 14, 2022
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
nusinersen,
cone-beam CT,
lumbar puncture
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2022 Vladka Salapura, Ziga Snoj, Lea Leonardis, Blaz Koritnik, Viktorija Kostadinova, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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