{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:31:41Z","timestamp":1785414701169,"version":"3.56.0"},"reference-count":19,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction\/Aims<\/jats:title><jats:p>Standard fluoroscopic lumbar puncture (LP) can be impossible in patients with severe spinal deformities from spinal muscular atrophy (SMA) who require intrathecal nusinersen therapy. There usually exists a straight trajectory in the lower sacral canal (SC) that could allow image\u2010guided percutaneous transsacral hiatus puncture of the lumbosacral dural sac. In this study we determine whether sacra are comparatively straighter in SMA patients (SMAps) vs healthy controls (HCs), which may facilitate unhindered transsacral hiatus spinal needle insertion for intrathecal nusinersen therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed lumbosacral spine computed tomograms (CTs) or CT\u2010myelogram images of 38 SMAps and age\u2010 and sex\u2010matched HCs. We digitally measured ventrodorsal sacral curvatures, SC surface areas, dural sac termination levels, and distances from sacral hiatus to the most caudad aspects of dural sacs (\u201cneedle distance\u201d).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean ages of HCs and SMAps were 32.7 and 31.7\u2009years, respectively, with dural sacs terminating at similar levels. Mean values for morphometrics were: (a) midsagittal SC surface area for HCs\u00a0=\u00a0701.2\u2009mm<jats:sup>2<\/jats:sup>, and for SMAps\u00a0=\u00a0601.5\u2009mm<jats:sup>2<\/jats:sup> (not statistically significant [ns]); (b) using a \u201cline method,\u201d sacral curvature for HCs\u00a0=\u00a061.9\u00b0, and SMAp\u00a0=\u00a035.7\u00b0 (<jats:italic>P<\/jats:italic>\u00a0=\u2009.0009), and was similar when using an \u201cangle summation method\u201d; (c) width of sacral hiatus for HCs\u00a0=\u00a014.9\u2009mm, and SMAps\u00a0=\u00a015.0\u2009mm (ns); and (d) \u201cneedle distance\u201d for HCs\u00a0=\u00a054.7\u2009mm, and SMAps\u00a0=\u00a049.9\u2009mm (ns).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>SMAps have significantly straighter sacra compared with HCs, which theoretically renders them more amenable to percutaneous transsacral hiatus puncture of the dural sac.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.27782","type":"journal-article","created":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T12:29:46Z","timestamp":1672230586000},"page":"226-230","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Feasibility of intrathecal therapeutic injections in spinal muscular atrophy patients via a percutaneous transsacral hiatus route: An initial neuroimaging morphometric study"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2826-955X","authenticated-orcid":false,"given":"Siddhant Suri","family":"Dhawan","sequence":"first","affiliation":[{"name":"Department of Bioengineering Stanford University Schools of Engineering and Medicine  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin","family":"Trinh","sequence":"additional","affiliation":[{"name":"Department of Radiology Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro\u2010Imaging in Translational Anatomy Research, Stanford University School of Medicine  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9694-1408","authenticated-orcid":false,"given":"Tarik F.","family":"Massoud","sequence":"additional","affiliation":[{"name":"Department of Radiology Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro\u2010Imaging in Translational Anatomy Research, Stanford University School of Medicine  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-020-00413-4"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000001049"},{"key":"e_1_2_10_4_1","first-page":"703","article-title":"Sagittal plane deformities in children with SMA2 following posterior spinal instrumentation","volume":"8","author":"Halanski MA","year":"2021","journal-title":"Children (Basel)."},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A5596"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2017.03.023"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2020-016058"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26082"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-9124-0"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-019-02189-x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000006006"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-018-4240-7"},{"key":"e_1_2_10_13_1","first-page":"e9525","article-title":"Intrathecal access through suboccipital port in patients with spinal muscular atrophy and complex spines: case series and technical note","volume":"12","author":"Tran DK","year":"2020","journal-title":"Cureus"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3171\/2019.2.SPINE181366"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27425"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23612"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.1330800311"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.169.4.9308486"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1984.tb07393.x"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-020-00949-8"}],"container-title":["Muscle &amp; Nerve"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.27782","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mus.27782","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.27782","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T19:46:49Z","timestamp":1692301609000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/mus.27782"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,11]]},"references-count":19,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1002\/mus.27782"],"URL":"https:\/\/doi.org\/10.1002\/mus.27782","archive":["Portico"],"relation":{},"ISSN":["0148-639X","1097-4598"],"issn-type":[{"value":"0148-639X","type":"print"},{"value":"1097-4598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,11]]},"assertion":[{"value":"2022-07-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}