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Feasibility of Intrathecal Therapeutic Injections in Spinal Muscular Atrophy Patients via a Percutaneous Trans-Sacral Hiatus Route: An Initial Neuroimaging Morphometric Study.
Feasibility of Intrathecal Therapeutic Injections in Spinal Muscular Atrophy Patients via a Percutaneous Trans-Sacral Hiatus Route: An Initial Neuroimaging Morphometric Study. Muscle & nerve Dhawan, S. S., Trinh, A., Massoud, T. F. 2022Abstract
INTRODUCTION/AIMS: Standard fluoroscopic lumbar puncture (LP) can be impossible in patients with severe spinal deformities from spinal muscular atrophy (SMA) who require intrathecal nusinersen therapy. There usually exists a straight trajectory in the lower sacral canal (SC) that could allow image-guided percutaneous trans-sacral hiatus puncture of the lumbosacral dural sac. Here, we determine if sacra are comparatively straighter in SMA patients (SMAps) versus healthy controls (HCs), which may facilitate unhindered trans-sacral hiatus spinal needle insertion for intrathecal nusinersen therapy.METHODS: We retrospectively analyzed lumbosacral spine computed tomograms (CTs) or CT-myelogram images of 38 SMAps and age- and sex-matched HCs. We digitally measured ventrodorsal sacral curvatures, SC surface areas, dural sac termination levels, and distances from sacral hiatus to the most caudad aspects of dural sacs ('needle distance').RESULTS: Mean ages of HCs and SMAps were 32.7 and 31.7years, respectively, with dural sacs terminating at similar levels. Mean values for morphometrics were: (a) Midsagittal SC surface area for HCs=701.2mm2 , and for SMAps=601.5mm2 (ns). (b) Using a 'line method', sacral curvature for HCs=61.9°, and SMAp=35.7° (p =0.0009), and was similar when using an 'angle summation method'. (c) Width of sacral hiatus for HCs=14.9mm, and SMAps=15.0mm (ns). (d) 'Needle distance' for HCs=54.7mm, and SMAps=49.9mm (ns).DISCUSSION: SMAps have significantly straighter sacra compared to HCs, which theoretically renders them more amenable to percutaneous trans-sacral hiatus puncture of the dural sac. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/mus.27782
View details for PubMedID 36576208