{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T16:37:08Z","timestamp":1789835828811,"version":"4.0.1"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>Nusinersen (Spinraza) is a US Food and Drug Administration\u2013approved intrathecal medication for the treatment of spinal muscular atrophy (SMA). Adult patients with SMA often undergo thoracolumbar fusion to treat neurogenic scoliosis, preventing thecal access. The authors report a laminotomy technique and the ease of intrathecal access in three SMA patients with prior thoracolumbar fusions.<\/jats:p><jats:p>Patients were positioned in the lateral decubitus position or prone. Lumbar laminotomy was performed below the conus, between the lateral longitudinal rods, to preserve mechanical stability. Fluoroscopy provided real-time identification of instruments. Hardware was contoured with a carbide drill bit to develop the surgical window. Fiducial screws were placed along the perimeter for demarcation. Sublaminar wire removal caused dural defects that were repaired with a layer of dural substitute onlay and sealant. All patients successfully received nusinersen thecal injections via lumbar puncture by an interventional radiologist. Fluoroscopy time ranged from 6 to 36 seconds. No postoperative pseudomeningoceles, cerebrospinal fluid leaks, or wound complications occurred.<\/jats:p><jats:p>For patients with SMA and posterior fusion from prior scoliosis treatment, lumbar laminotomy is an effective method for creating thecal access for the administration of nusinersen.<\/jats:p>","DOI":"10.3171\/2019.2.spine181366","type":"journal-article","created":{"date-parts":[[2019,4,19]],"date-time":"2019-04-19T13:00:51Z","timestamp":1555678851000},"page":"217-221","source":"Crossref","is-referenced-by-count":16,"title":["Lumbar laminotomy for the intrathecal administration of nusinersen for spinal muscular atrophy: technical note and outcomes"],"prefix":"10.3171","volume":"31","author":[{"given":"Diana","family":"Ko","sequence":"first","affiliation":[{"name":"School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Blatt","sequence":"additional","affiliation":[{"name":"School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chafic","family":"Karam","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunal","family":"Gupta","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Raslan","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Muscle Nerve","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1002\/mus.24497","article-title":"Spinal muscular atrophy: diagnosis and management in a new therapeutic era","volume":"51","author":"Arnold WD","year":"2015","unstructured":"Arnold WD, Kassar D, Kissel JT: Spinal muscular atrophy: diagnosis and management in a new therapeutic era. Muscle Nerve 51:157\u2013167, 201510.1002\/mus.24497"},{"issue":"7","key":"b2","series-title":"Front Mol Biosci","doi-asserted-by":"publisher","DOI":"10.3389\/fmolb.2016.00007","article-title":"Copy number variations in the survival motor neuron genes: implications for spinal muscular atrophy and other neurodegenerative diseases","volume":"3","author":"Butchbach ME","year":"2016","unstructured":"Butchbach ME: Copy number variations in the survival motor neuron genes: implications for spinal muscular atrophy and other neurodegenerative diseases. Front Mol Biosci 3:7, 201610.3389\/fmolb.2016.0000727014701"},{"key":"b3","series-title":"Pediatr Clin North Am","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1016\/j.pcl.2015.03.010","article-title":"Spinal muscular atrophies","volume":"62","author":"Darras BT","year":"2015","unstructured":"Darras BT: Spinal muscular atrophies. Pediatr Clin North Am 62:743\u2013766, 20152602217310.1016\/j.pcl.2015.03.010"},{"key":"b4","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"3017","DOI":"10.1016\/S0140-6736(16)31408-8","article-title":"Treatment of infantile-onset spinal muscular atrophy with nusinersen: a phase 2, open-label, dose-escalation study","volume":"388","author":"Finkel RS","year":"2016","unstructured":"Finkel RS, Chiriboga CA, Vajsar J, Day JW, Montes J, De Vivo DC, : Treatment of infantile-onset spinal muscular atrophy with nusinersen: a phase 2, open-label, dose-escalation study. Lancet 388:3017\u20133026, 20162793905910.1016\/S0140-6736(16)31408-8"},{"key":"b5","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1056\/NEJMoa1702752","article-title":"Nusinersen versus sham control in infantile-onset spinal muscular atrophy","volume":"377","author":"Finkel RS","year":"2017","unstructured":"Finkel RS, Mercuri E, Darras BT, Connolly AM, Kuntz NL, Kirschner J, : Nusinersen versus sham control in infantile-onset spinal muscular atrophy. N Engl J Med 377:1723\u20131732, 201710.1056\/NEJMoa170275229091570"},{"key":"b6","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"e505","DOI":"10.1097\/BPO.0000000000001049","article-title":"Outcomes of primary posterior spinal fusion for scoliosis in spinal muscular atrophy: clinical, radiographic, and pulmonary outcomes and complications","volume":"37","author":"Holt JB","year":"2017","unstructured":"Holt JB, Dolan LA, Weinstein SL: Outcomes of primary posterior spinal fusion for scoliosis in spinal muscular atrophy: clinical, radiographic, and pulmonary outcomes and complications. J Pediatr Orthop 37:e505\u2013e511, 201710.1097\/BPO.000000000000104928777284"},{"key":"b7","series-title":"Paediatr Anaesth","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1111\/pan.12159","article-title":"Anesthesia and spinal muscle atrophy","volume":"23","author":"Islander G","year":"2013","unstructured":"Islander G: Anesthesia and spinal muscle atrophy. Paediatr Anaesth 23:804\u2013816, 20132360114510.1111\/pan.12159"},{"key":"b8","series-title":"Neurol Clin","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1016\/j.ncl.2015.07.004","article-title":"Spinal muscular atrophy","volume":"33","author":"Kolb SJ","year":"2015","unstructured":"Kolb SJ, Kissel JT: Spinal muscular atrophy. Neurol Clin 33:831\u2013846, 20152651562410.1016\/j.ncl.2015.07.004"},{"key":"b9","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1056\/NEJMoa1710504","article-title":"Nusinersen versus sham control in later-onset spinal muscular atrophy","volume":"378","author":"Mercuri E","year":"2018","unstructured":"Mercuri E, Darras BT, Chiriboga CA, Day JW, Campbell C, Connolly AM, : Nusinersen versus sham control in later-onset spinal muscular atrophy. N Engl J Med 378:625\u2013635, 201810.1056\/NEJMoa171050429443664"},{"key":"b10","series-title":"J Am Acad Orthop Surg","doi-asserted-by":"publisher","first-page":"393","DOI":"10.5435\/JAAOS-20-06-393","article-title":"Spinal muscular atrophy: manifestations and management","volume":"20","author":"Mesfin A","year":"2012","unstructured":"Mesfin A, Sponseller PD, Leet AI: Spinal muscular atrophy: manifestations and management. J Am Acad Orthop Surg 20:393\u2013401, 201210.5435\/JAAOS-20-06-39322661569"},{"key":"b11","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1007\/s00247-018-4206-9","article-title":"A comprehensive institutional overview of intrathecal nusinersen injections for spinal muscular atrophy","volume":"48","author":"Mousa MA","year":"2018","unstructured":"Mousa MA, Aria DJ, Schaefer CM, Kaye RD, Abruzzo TA, Bernes SM, : A comprehensive institutional overview of intrathecal nusinersen injections for spinal muscular atrophy. Pediatr Radiol 48:1797\u20131805, 201810.1007\/s00247-018-4206-930022258"},{"key":"b12","series-title":"Nippon Yakurigaku Zasshi","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1254\/fpj.152.147","article-title":"[Pharmacological and clinical profile of spinal muscular atrophy (SMA) therapeutic drug nusinersen (Spinraza\u00ae)","volume":"152","author":"Ohmura T","year":"2018","unstructured":"Ohmura T, Saeki S, Ogiwara K, Tobita K, Ling Y, Torii S: [Pharmacological and clinical profile of spinal muscular atrophy (SMA) therapeutic drug nusinersen (Spinraza\u00ae).] Nippon Yakurigaku Zasshi 152:147\u2013159, 2018 (Jpn)10.1254\/fpj.152.14730185733"},{"key":"b13","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1007\/s00247-018-4240-7","article-title":"Ultrasound-guided cervical puncture for nusinersen administration in adolescents","volume":"49","author":"Ortiz CB","year":"2019","unstructured":"Ortiz CB, Kukreja KU, Lotze TE, Chau A: Ultrasound-guided cervical puncture for nusinersen administration in adolescents. Pediatr Radiol 49:136\u2013140, 20193016776410.1007\/s00247-018-4240-7"},{"key":"b14","series-title":"GeneReviews\u00ae","article-title":"Spinal muscular atrophy","author":"Prior TW","year":"1993","unstructured":"Prior TW, Finanger E: Spinal muscular atrophy, in Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Stephens K,  (eds): GeneReviews\u00ae. Seattle: University of Washington, 1993"},{"key":"b15","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1007\/BF00301032","article-title":"Scoliosis and lung function in spinal muscular atrophy","volume":"4","author":"Robinson D","year":"1995","unstructured":"Robinson D, Galasko CS, Delaney C, Williamson JB, Barrie JL: Scoliosis and lung function in spinal muscular atrophy. Eur Spine J 4:268\u2013273, 199510.1007\/BF003010328581526"},{"key":"b16","series-title":"J Child Neurol","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1177\/088307388900400208","article-title":"Scoliosis in spinal muscular atrophy: review of 63 cases","volume":"4","author":"Rodillo E","year":"1989","unstructured":"Rodillo E, Marini ML, Heckmatt JZ, Dubowitz V: Scoliosis in spinal muscular atrophy: review of 63 cases. J Child Neurol 4:118\u2013123, 1989278554810.1177\/088307388900400208"},{"key":"b17","series-title":"Brain Pathol","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1111\/j.1750-3639.2001.tb00395.x","article-title":"Spinal muscular atrophy: present state","volume":"11","author":"Schmalbruch H","year":"2001","unstructured":"Schmalbruch H, Haase G: Spinal muscular atrophy: present state. Brain Pathol 11:231\u2013247, 20011130379810.1111\/j.1750-3639.2001.tb00395.x"},{"issue":"Suppl 4","key":"b18","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"S245","DOI":"10.1542\/peds.2008-2952K","article-title":"Special considerations in the respiratory management of spinal muscular atrophy","volume":"123","author":"Schroth MK","year":"2009","unstructured":"Schroth MK: Special considerations in the respiratory management of spinal muscular atrophy. Pediatrics 123 (Suppl 4):S245\u2013S249, 20091942015410.1542\/peds.2008-2952K"},{"key":"b19","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/01241398-200301000-00002","article-title":"Hip dislocation in patients with spinal muscular atrophy","volume":"23","author":"Sporer SM","year":"2003","unstructured":"Sporer SM, Smith BG: Hip dislocation in patients with spinal muscular atrophy. J Pediatr Orthop 23:10\u201314, 20031249993510.1097\/01241398-200301000-00002"},{"key":"b20","series-title":"Ther Adv Neurol Disorder","article-title":"Feasibility and safety of intrathecal treatment with nusinersen in adult patients with spinal muscular atrophy","volume":"11","author":"Stolte B","unstructured":"Stolte B, Totzeck A, Kizina K, Bolz S, Pietruck L, M\u00f6nninghoff C, : Feasibility and safety of intrathecal treatment with nusinersen in adult patients with spinal muscular atrophy. Ther Adv Neurol Disorder 11:1756286418803246, 2018"},{"key":"b21","series-title":"Methods Mol Biol","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1007\/978-1-4939-8651-4_27","article-title":"In vitro evaluation of antisense-mediated exon inclusion for spinal muscular atrophy","volume":"1828","author":"Touznik A","year":"2018","unstructured":"Touznik A, Maruyama R, Yokota T: In vitro evaluation of antisense-mediated exon inclusion for spinal muscular atrophy. Methods Mol Biol 1828:439\u2013454, 201810.1007\/978-1-4939-8651-4_2730171558"},{"key":"b22","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"e620","DOI":"10.1212\/WNL.0000000000006006","article-title":"Cervical puncture to deliver nusinersen in patients with spinal muscular atrophy","volume":"91","author":"Veerapandiyan A","year":"2018","unstructured":"Veerapandiyan A, Pal R, D\u2019Ambrosio S, Young I, Eichinger K, Collins E, : Cervical puncture to deliver nusinersen in patients with spinal muscular atrophy. Neurology 91:e620\u2013e624, 20183000641010.1212\/WNL.0000000000006006"},{"key":"b23","series-title":"Proc Natl Acad Sci U S A","doi-asserted-by":"publisher","first-page":"E4604","DOI":"10.1073\/pnas.1800260115","article-title":"Mechanistic studies of a small-molecule modulator of SMN2 splicing","volume":"115","author":"Wang J","year":"2018","unstructured":"Wang J, Schultz PG, Johnson KA: Mechanistic studies of a small-molecule modulator of SMN2 splicing. Proc Natl Acad Sci U S A 115:E4604\u2013E4612, 201810.1073\/pnas.180026011529712837"},{"key":"b24","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1007\/s00247-017-4031-6","article-title":"Transforaminal intrathecal delivery of nusinersen using cone-beam computed tomography for children with spinal muscular atrophy and extensive surgical instrumentation: early results of technical success and safety","volume":"48","author":"Weaver JJ","year":"2018","unstructured":"Weaver JJ, Natarajan N, Shaw DWW, Apkon SD, Koo KSH, Shivaram GM, : Transforaminal intrathecal delivery of nusinersen using cone-beam computed tomography for children with spinal muscular atrophy and extensive surgical instrumentation: early results of technical success and safety. Pediatr Radiol 48:392\u2013397, 201810.1007\/s00247-017-4031-629130140"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/31\/2\/article-p217.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/31\/2\/article-p217.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/31\/2\/article-p217.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T22:42:38Z","timestamp":1681598558000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/31\/2\/article-p217.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":24,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2019.2.spine181366","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}