Abstract：
BACKGROUND: Complex spinal deformities necessitate surgical interventions that may intervene with intrathecal injections in patients with spinal muscular atrophy (SMA). This study aimed to determine the effect of spinal deformity correction surgery on nusinersen administration.
METHODS: Pediatric patients with SMA, operated by a single surgeon, either via magnetically controlled growing rod (MCGR) or definitive fusion (DF) with skip instrumentation, were evaluated retrospectively in terms of safety and feasibility of intrathecal injections. Patients\' and their parents\' perspectives were evaluated through a questionnaire regarding any shift in the setting of injections.
RESULTS: Fourteen patients with 15 spinal surgeries (10 MCGR and 5 DF) were included. Eleven patients received intrathecal treatment both before and after the surgery. Preoperative (n=3) and postoperative (n=9) fluoroscopic guidance was required leading to a shift in the application settings in 6 patients. Of 106 preoperative injections, 15% required fluoroscopy and 2% required anesthesia. Postoperatively, of 88 injections, 73% required fluoroscopy and 26% required anesthesia. No patients discontinued intrathecal injections due to technical difficulties associated with the spinal surgery.
CONCLUSIONS: This study demonstrates that spinal surgery does not prevent safe and successful intrathecal nusinersen injections. In the DF group, the skip instrumentation technique provided access to interlaminal space for intrathecal injections. In either surgical group, no further auxillary approach was required. Modifications in the injection technique require an institutional approach, and concerns of patients and their families should be addressed accordingly.
METHODS: IV.
METHODS: Pediatric patients with SMA, operated by a single surgeon, either via magnetically controlled growing rod (MCGR) or definitive fusion (DF) with skip instrumentation, were evaluated retrospectively in terms of safety and feasibility of intrathecal injections. Patients\' and their parents\' perspectives were evaluated through a questionnaire regarding any shift in the setting of injections.
RESULTS: Fourteen patients with 15 spinal surgeries (10 MCGR and 5 DF) were included. Eleven patients received intrathecal treatment both before and after the surgery. Preoperative (n=3) and postoperative (n=9) fluoroscopic guidance was required leading to a shift in the application settings in 6 patients. Of 106 preoperative injections, 15% required fluoroscopy and 2% required anesthesia. Postoperatively, of 88 injections, 73% required fluoroscopy and 26% required anesthesia. No patients discontinued intrathecal injections due to technical difficulties associated with the spinal surgery.
CONCLUSIONS: This study demonstrates that spinal surgery does not prevent safe and successful intrathecal nusinersen injections. In the DF group, the skip instrumentation technique provided access to interlaminal space for intrathecal injections. In either surgical group, no further auxillary approach was required. Modifications in the injection technique require an institutional approach, and concerns of patients and their families should be addressed accordingly.
METHODS: IV.
摘要：
背景：复杂的脊柱畸形需要对脊髓性肌萎缩（SMA）患者进行鞘内注射的手术干预。这项研究旨在确定脊柱畸形矫正手术对nusinersen给药的影响。
方法：患有SMA的儿科患者，由一名外科医生操作，通过磁控生长棒(MCGR)或带有跳跃仪器的最终融合(DF)，回顾性评估鞘内注射的安全性和可行性。通过关于注射设置的任何变化的问卷评估了患者及其父母的观点。
结果：包括14例患者，其中15例脊柱手术（10例MCGR和5例DF）。11例患者在手术前后均接受鞘内治疗。术前（n=3）和术后（n=9）需要透视指导，导致6例患者的应用设置发生变化。术前注射106次，15%需要透视，2%需要麻醉。术后,88次注射，73%需要透视，26%需要麻醉。没有患者由于与脊柱手术相关的技术困难而停止鞘内注射。
结论：这项研究表明，脊柱手术并不能阻止鞘内注射nusinersen的安全和成功。在DF组中，跳过器械技术提供了椎间间隙的鞘内注射通道.在任何一组手术中，不需要进一步的辅助方法.注入技术的修改需要体制方法，患者及其家人的关切应得到相应解决。
方法：IV.
方法：患有SMA的儿科患者，由一名外科医生操作，通过磁控生长棒(MCGR)或带有跳跃仪器的最终融合(DF)，回顾性评估鞘内注射的安全性和可行性。通过关于注射设置的任何变化的问卷评估了患者及其父母的观点。
结果：包括14例患者，其中15例脊柱手术（10例MCGR和5例DF）。11例患者在手术前后均接受鞘内治疗。术前（n=3）和术后（n=9）需要透视指导，导致6例患者的应用设置发生变化。术前注射106次，15%需要透视，2%需要麻醉。术后,88次注射，73%需要透视，26%需要麻醉。没有患者由于与脊柱手术相关的技术困难而停止鞘内注射。
结论：这项研究表明，脊柱手术并不能阻止鞘内注射nusinersen的安全和成功。在DF组中，跳过器械技术提供了椎间间隙的鞘内注射通道.在任何一组手术中，不需要进一步的辅助方法.注入技术的修改需要体制方法，患者及其家人的关切应得到相应解决。
方法：IV.
