Ultrasound-guided lumbar puncture for nusinersen administration in Spinal Muscular Atrophy (SMA) patients.

OBJECTIVE To report results of ultrasound-guided lumbar puncture for the administration of nusinersen in spinal muscular atrophy (SMA) patients with complex spines. METHODS Eighteen SMA patients (5 children, 5 adolescents and 8 adults) with either severe scoliosis or spondylodesis were evaluated for ultrasound-guided lumbar puncture. Ultrasound was performed with 3.5 MHz transducer to guide a 22g x 15 mm needle, which was placed into the posterior lumbar space following a parasagittal interlaminar approach. RESULTS Twelve patients had undergone spinal instrumentation (9 growing rods and 3 spinal fusion) while the other six showed severe scoliosis. Success was achieved in 91/94 attempts (96.8%), in 14/18 patients (77.8%), including 100% of children and adolescent and 50% of adult patients. In two of these unsuccessfully treated patients, CT and fluoroscopy-guided transforaminal lumbar punctures were also tried without success. After a median follow up of 14 months only few adverse events, mostly mild, were observed. CONCLUSION The ultrasound-guided lumbar puncture, following an interlaminar parasagittal approach, is a safe and effective approach for the intrathecal treatment with nusinersen in children, adolescents and carefully selected adult SMA patients with complex spines, and could be considered the first option in them.