Ultra-low radiation dose protocol for CT-guided intrathecal nusinersen injections for patients with spinal muscular atrophy and severe scoliosis

Abstract

Purpose Intrathecal injection of nusinersen is an approved treatment of spinal muscular atrophy (SMA). CT-guided injection is a method of nusinersen administration in patients with severe scoliosis, in whom standard lumbar puncture is not feasible. The injections are repeated every 4 months for life, and accumulated radiation doses absorbed by the patient can increase the risk of cancer. In this study, we present the results of CT-guided intrathecal nusinersen injections with an ultra-low radiation dose protocol. Methods Eighteen patients (15 adults and three children) in whom standard lumbar puncture was not feasible due to severe scoliosis or spinal stabilization were included in this retrospective study. The first 23 injections were performed with a standard radiation dose protocol and the next 42 injections with an ultra-low-dose protocol. The radiation doses, measured as total dose length product (DLP), were acquired and compared between the protocols. Results Injections were successful in 100% of patients with both ultra-low-dose and standard protocols. The radiation dose, measured as DLP, was 111.2–1100.7 (Me = 248.1) mGy*cm for the standard protocol. For the ultra-low-dose protocol, the dose range was 5.0–54.4 (Me = 26.7) mGy*cm, which was significantly lower than with the standard protocol (p < 0.001, η2 = 0.67). Conclusion Radiation doses can be significantly decreased in the CT-guided injection of nusinersen. The proposed protocol allows for effective CT-guided intrathecal nusinersen administration in patients with SMA and severe scoliosis.

Needleless inhaled anesthesia with sevoflurane: Advantages of a simplified approach for children with spinal muscular atrophy undergoing intrathecal administration of nusinersen

“…Given the absence of intravenous access, it was important to perform anesthesia and administer nusinersen in a reasonable time. A comparison with other studies about this point was out of scope of our study; however, mean operation time would seem shorter than in other studies that used imaging guidance 44–47 . Only a minority of procedures reached 30 min in duration, mainly due to the need to perform multiple punctures.…”

“…A comparison with other studies about this point was out of scope of our study; however, mean operation time would seem shorter than in other studies that used imaging guidance. [44][45][46][47] Only a minority of procedures reached 30 min in duration, mainly due to the need to perform multiple punctures. However, the increase in procedure time did not force changes in the predetermined anesthesiologic procedure to be performed.…”

Scoliosis Orthopedic Surgery Combined With Nusinersen Intrathecal Injection Significantly Improved the Outcome of Spinal Muscular Atrophy Patient: A Case Report

“…It always takes a period of time to find the vertebral space using ultrasound, and the longer operation time brings more discomfort to the patient ( 22 ). CT-guided intrathecal injection is a feasible method of Nusinersen administration for patients with difficult lumbar puncture because of the severe scoliosis or spinal stabilization with a high technical success rate ( 23 ). In this case, CT-guided puncture required less operative time, a lower local anesthetic dose, and lower VAS score after the procedure compared with ultrasound guidance.…”

Radiation dose in CT-guided microwave liver tumor ablation

“…The majority of radiation doses in CT--guided procedures comes from helical scans [12]. Limiting such scans by replacing some of them with quick-check scans can significantly reduce the radiation dose in CT-guided procedures [13]. However, it can be difficult in such complex procedures as ablations where the operator needs to have high quality visualizations of large volumes of liver tissue.…”