Lumbar laminotomy for the intrathecal administration of nusinersen for spinal muscular atrophy: Technical note and outcomes

Diana Ko, Daniel Blatt, Chafic Karam, Kunal Gupta, Ahmed M. Raslan

Research output: Contribution to journalArticle

Abstract

Nusinersen (Spinraza) is a US Food and Drug Administration–approved intrathecal medication for the treatment of spinal muscular atrophy (SMA). Adult patients with SMA often undergo thoracolumbar fusion to treat neurogenic scoliosis, preventing thecal access. The authors report a laminotomy technique and the ease of intrathecal access in three SMA patients with prior thoracolumbar fusions. Patients were positioned in the lateral decubitus position or prone. Lumbar laminotomy was performed below the conus, between the lateral longitudinal rods, to preserve mechanical stability. Fluoroscopy provided real-time identification of instruments. Hardware was contoured with a carbide drill bit to develop the surgical window. Fiducial screws were placed along the perimeter for demarcation. Sublaminar wire removal caused dural defects that were repaired with a layer of dural substitute onlay and sealant. All patients successfully received nusinersen thecal injections via lumbar puncture by an interventional radiologist. Fluoroscopy time ranged from 6 to 36 seconds. No postoperative pseudomeningoceles, cerebrospinal fluid leaks, or wound complications occurred. For patients with SMA and posterior fusion from prior scoliosis treatment, lumbar laminotomy is an effective method for creating thecal access for the administration of nusinersen.

Original languageEnglish (US)
Pages (from-to)217-221
Number of pages5
JournalJournal of Neurosurgery: Spine
Volume31
Issue number2
DOIs
StatePublished - Jan 1 2019

Fingerprint

Spinal Muscular Atrophy
Laminectomy
Fluoroscopy
Scoliosis
Prone Position
Inlays
Mandrillus
Spinal Puncture
Food
Injections
Wounds and Injuries
Therapeutics
Pharmaceutical Preparations

Keywords

  • Lumbar laminotomy
  • Lumbar puncture
  • Nusinersen
  • Spinal muscular atrophy
  • Surgical technique

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Lumbar laminotomy for the intrathecal administration of nusinersen for spinal muscular atrophy : Technical note and outcomes. / Ko, Diana; Blatt, Daniel; Karam, Chafic; Gupta, Kunal; Raslan, Ahmed M.

In: Journal of Neurosurgery: Spine, Vol. 31, No. 2, 01.01.2019, p. 217-221.

Research output: Contribution to journalArticle

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