Comparison of fluoroscopy-guided and blind techniques in intrathecal nusinersen administration

Abstract

Background & Objectives: Intrathecal nusinersen administration is often performed using a blind technique without any imaging guidance. However, many patients with spinal muscular atrophy(SMA) have progressive and severe scoliosis, making intrathecal access challenging. In patients where intrathecal access is difficult, injections can be performed under imaging guidance, such as fluoroscopy. This study aimed to compare blind versus fluoroscopy-guided intrathecal nusinersen injections in patients with SMA, focusing on postprocedural pain and patient satisfaction.

Method: SMA patients who underwent both blind intrathecal nusinersen injections and fluoroscopy-guided intrathecal nusinersen injections between January2022 and June2023 were retrospectively analyzed. Patient satisfaction (5-point Likert scale) and postprocedural pain levels (Numeric Rating Scale, 0–10) were assessed after both the blind and fluoroscopy-guided procedures, and the results were compared.

Results: This study included 79 fluoroscopy-guided intrathecal nusinersen injections administered to 26 patients during the specified period. The satisfaction score for the fluoroscopy-guided technique (FT) was 5, while it was 2.32±1.31 for the blind technique (BT). Post-procedural pain in the FT was 0.73±0.72, compared to 4.77±1.58 in the BT. Satisfaction in the FT was significantly higher than in the BT, while postprocedural pain scores were significantly lower (p<0.001). Success rate was 71.5% with the BT, whereas it was 100% with the FT (p<0.001).

Conclusion: Administering intrathecal nusinersen with fluoroscopy guidance enhances patient satisfaction and minimizes postprocedural pain in SMA. Additionally, performing the injections under fluoroscopic guidance increases the success rate of the procedure and reduces the risk of potential complications. Therefore, in cases where intrathecal access may be challenging, such as in patients with scoliosis, nusinersen administration could be more appropriately performed by experienced practitioners using fluoroscopic guidance rather than a blind technique.