Transforaminal lumbar puncture for intrathecal access: Case series with literature review and comparison to other techniques

Velayudhan, Vinodkumar; Patel, Sandhya; Danziger, Andrew; Grigorian, Arkadij; Waite, Stephen; Efendizade, Aslan

doi:10.1016/j.jocn.2019.12.056

Cited by 8 publications

(5 citation statements)

References 23 publications

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“…Nonetheless, other investigators have recently reported a considerable number of adverse events, including one severe subarachnoid haemorrhage [6]. Notably, published data regarding nusinersen intrathecal administration via the transforaminal approach include approximately 50 patients and 200 punctures [5][6][7][8][9][10][11][12]. Therefore, the feasibility and safety of computed-tomography-guided (CT-guided) transforaminal nusinersen intrathecal injection has not yet been established, whilst radiation dose remains an issue.…”

Section: Introductionmentioning

confidence: 99%

Computed‐tomography‐guided transforaminal intrathecal nusinersen injection in adults with spinal muscular atrophy type 2 and severe spinal deformity. Feasibility, safety and radiation exposure considerations

Spiliοpoulos

Reppas

Zompola

et al. 2020

Euro J of Neurology

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Background and purpose: The purpose was to investigate our centre's experience on computed-tomography-guided (CT-guided), transforaminal, intrathecal administration of nusinersen in adult subjects with spinal muscular atrophy (SMA) type 2 and severe spinal deformity. Method: This is a retrospective, single-centre study investigating the feasibility and safety of CT-guided, transforaminal, lumbar puncture for the intrathecal administration of nusinersen (SpinranzaÒ; Biogen; Cambridge, MA, USA) in a cohort of adult subjects with SMA type 2, severe neuromuscular scoliosis and previous spinal surgery. Between January 2019 and October 2019, five male, adult, SMA type 2 subjects were eligible to be treated in our centre with nusinersen. The mean age of the patients was 31 AE 9 years (range 19-43 years). The study's outcome measures were technical success, adverse events and radiation exposure. Results: In total, four patients completed the four loading doses, whilst the fifth patient received only one loading dose; two patients also received their first maintenance doses. Overall, 20 consecutive transforaminal, intrathecal treatments were analysed. Technical success was 100% (20/20 intrathecal infusions). No adverse events were documented following the procedures. Mean dose-length product (DLP) value per injection was 665.4 AE 715.5 mGy*cm. Estimated mean effective dose per injection was 12.7 AE 12.9 mSv. Subgroup analysis between the chronologically first 10 versus subsequent 10 procedures demonstrated a clear trend towards less radiation exposure in the latter, although this difference did not reach statistical significance (DLP: 984.7 AE 903.3 vs. 436.7 AE 321.5 mGy*cm, P = 0.165; respectively). Conclusions: In this retrospective series, CT-guided transforaminal access for intrathecal injection of nusinersen was proven feasible and safe. A decrease in radiation dose over time was noted. Protocols to minimize radiation exposure are essential.

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Section: Introductionmentioning

confidence: 99%

Computed‐tomography‐guided transforaminal intrathecal nusinersen injection in adults with spinal muscular atrophy type 2 and severe spinal deformity. Feasibility, safety and radiation exposure considerations

Spiliοpoulos

Reppas

Zompola

et al. 2020

Euro J of Neurology

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“…Most the articles were published in the first half of 2020. Velayudhan et al 9 published a series of 17 transforaminal injections in 3 patients, all of whom underwent a preprocedural planning CT and they used CT guidance for the procedure. Either a 20-ga or 22-ga Quincke needle was used for the procedure.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Procedural Complications from Transforaminal Lumbar Puncture for Intrathecal Nusinersen Administration in Patients with Spinal Muscular Atrophy

Grayev

Schoepp

Kuner

2021

AJNR Am J Neuroradiol

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“…There have been reports on alternative methods focusing on reducing the difficulties in intrathecal injection for SMA patients with severe scoliotic spinal deformation and even those accepting spinal fusion surgery, including placement of intrathecal port catheter ( 6 ) or Ommaya reservoir ( 7 ), transforaminal intrathecal delivery ( 8 ), fluoroscopic lumbar puncture ( 9 ), and computed tomography-guided injection ( 10 ). To date, no MIIM especially for nusinersen treatment has been reported.…”

Section: Discussionmentioning

confidence: 99%

Modified nusinersen intrathecal injection method: inclusion of a septal needle-free closed infusion connector

Zhang,

Zheng,

Liang

et al. 2023

Front. Neurol.

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ObjectiveNusinersen, an extremely expensive biologic drug (around 100,000 US$ per dose) that needs to be administered intrathecally, is approved for the treatment of 5q-spinal muscular atrophy (SMA). Because of the low muscle tone of the back muscles of pediatric SMA patients, especially type 1 SMA patients, the safe, effective, and fast execution of sheath injection is needed. Therefore, a modified intrathecal injection method was developed accordingly. This paper aims to describe the applicability and safety of this modified method.MethodsThe modified intrathecal injection method (MIIM) mainly includes a septal needle-free closed infusion connector between the lumbar puncture needle and the syringe, besides the procedures of routine lumbar puncture. Its applicability and safety were evaluated through clinical observation.ResultsA total of 92 children with SMA have successfully received nusinersen treatment at our hospital using the modified method since 2019 without obvious adverse events related to the modified injection method. Based on the clinical feedback of operators, the advantages of the modified method include successfully injecting the total dose of nusinersen with constant injection rate and a more stable fixation of the puncture needle, as well as making the operator more relaxed. However, compared with the routine method, the procedure of the modified method has additional steps.ConclusionThe modified intrathecal injection method is an effective and safe method to inject nusinersen when weighing the pros and cons, and it may also be used for administering intrathecal injections of other expensive medicines or for patients with other strict requirements for intrathecal injection.

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Transforaminal lumbar puncture for intrathecal access: Case series with literature review and comparison to other techniques

Cited by 8 publications

References 23 publications

Computed‐tomography‐guided transforaminal intrathecal nusinersen injection in adults with spinal muscular atrophy type 2 and severe spinal deformity. Feasibility, safety and radiation exposure considerations

Computed‐tomography‐guided transforaminal intrathecal nusinersen injection in adults with spinal muscular atrophy type 2 and severe spinal deformity. Feasibility, safety and radiation exposure considerations

A Systematic Review of Procedural Complications from Transforaminal Lumbar Puncture for Intrathecal Nusinersen Administration in Patients with Spinal Muscular Atrophy

Modified nusinersen intrathecal injection method: inclusion of a septal needle-free closed infusion connector

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