A new technique for transforaminal lumbar puncture under computed tomography (CT) guidance using local anesthesia and a straight 22-gauge needle allows reliable access to the intrathecal space and is easily reproducible. It can, therefore, be used to administer nusinersen to patients with spinal muscular atrophy (SMA), according to a new study published in Interventional Neuroradiology.

Nusinersen (Spinraza®) is the first treatment approved by the US Food and Drug Administration (FDA) for SMA. Because it cannot cross the blood-brain barrier, the treatment must be injected intrathecally. Treatment includes 4 loading doses followed by maintenance treatment every 4 months.

Reliable intrathecal access can be challenging, especially in older patients who might have had prior lumbar instrumentation and osseous fusion. In the present study, a team of researchers led by Bryan Pukenas, MD, from the Section of Neurointerventional Radiology, Perelman School of Medicine, University of Pennsylvania in Philadelphia describe a new technique that can allow reliable intrathecal access to administer nusinersen in patients with SMA.

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The researchers analyzed the outcomes of 77 transforaminal lumbar punctures for intrathecal administration of nusinersen. Local anesthesia was used in 76 procedures, while conscious sedation was used in 1 case. The researchers found that there were no major complications in any case, including neurological deficits, bleeding complications, or infections.

“Our experience shows that reliable intrathecal access can be obtained via the transforaminal route using CT guidance, local anesthetic, and a straight 22-gauge needle,” the researchers wrote.

One limitation of this study is that it does not compare the described technique with other techniques like conventional fluoroscopy- and cone-beam CT-guided approaches.


Cox M, Atsina KB, Ramchand P, Ji J, Sedora-Roman N, Pukenas B. Computed tomography-guided transforaminal lumbar puncture using local anesthesia and a straight 22-gauge spinal needle for intrathecal nusinersen in adults: findings in 77 procedures. Interv Neuroradiol. Published online August 23, 2021. doi:10.1177/15910199211032842