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


Background:

Spinal muscular atrophy is a progressive neurodegenerative disorder that can be treated with intrathecal antisense oligonucleotide therapy (nusinersen). However, administration is often complicated by posterior spinal fusion and neuromuscular scoliosis, necessitating a transforaminal approach.


Purpose:

To assess the safety profile of the transforaminal approach for intrathecal access.


Data sources:

Searches of the PubMed, Web of Science, and SCOPUS databases.


Study selection:

Thirteen articles were selected based on inclusion of transforaminal access and appropriate clinical information about the procedure.


Data analysis:

Complications were taken from the included articles and aggregated based on Cardiovascular and Interventional Radiological Society of Europe scale adverse event grading.


Data synthesis:

Total number of complications and grade of complications were analyzed, by year and in total.


Limitations:

Selection bias in publication, small patient population size, and variability of the procedure limits the available data.


Conclusions:

Transforaminal approach is a safe alternative for intrathecal access in patients with spinal muscular atrophy and may be applicable to a larger patient population.

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