Patel Manish,  Weiss Judith,  Kandil Ali,  Johnson Neil

Final Pr. ID: Poster #: SCI-034

Patients with Spinal Muscular Atrophy (SMA) may have scoliosis requiring spinal hardware for spinal fixation. The scoliosis in addition to the spinal hardware makes intrathecal access difficult with conventional approaches. With recent FDA approval of nusinersen (SpinrazaÒ) for SMA, intrathecal access is required for administration of this meditation. We describe our experience in these patients using a variety of lumbar puncture approaches (intra-spinous process, trans-pedicle, and trans-foraminal) utilizing conventional fluoroscopy, cone-beam CT (CBCT) with fluoroscopy overlay and/or conventional CT with CT fluoroscopy. Approach to the type of access and image guidance is based on the presence of spinal hardware and degree of scoliosis and spinal fusion. Read More

Authors:  Patel Manish , Weiss Judith , Kandil Ali , Johnson Neil

Keywords:  Spinal Muscular Atrophy, Lumbar Puncture, Spinraza

Cielma Tara,  Bandarkar Anjum

Final Pr. ID: Poster #: EDU-006 (R)

Background:
Lumbar puncture (LP) is used during the initial work-up of a febrile infant for diagnosis of central nervous system (CNS) abnormalities such as neoplasm, and infectious processes. In children, the L3-L4 and L4-L5 intervertebral space can be used to access the subarachnoid space. Collection of cerebral spinal fluid (CSF) is then tested for any markers of infection. At times, a lumbar puncture may fail and create a leak of CSF and hematoma within the meningeal space.

Purpose:
Through this case series, we will describe normal sonographic anatomy of the spinal canal and effective techniques to best demonstrate epidural hematoma post lumbar puncture. Retrospective review of ultrasound B-mode and cine loop images was performed with respect to the three cases. Typical imaging features include heterogenously echogenic material within the dorsal and ventral epidural space that may move with real-time patient motion. Additionally, the collection of material may compress the thecal sac, obliterating flow of CSF.
High frequency linear sonography of the spinal canal and epidural space after unsuccessful lumbar puncture in experienced hands can adequately demonstrate anatomic detail of the spine and meningeal spaces and identify the epidural hematoma. Ultrasound allows expedited diagnosis of traumatic epidural hematoma after failed lumbar puncture and facilitates ultrasound-guided CSF collection. Read More

Authors:  Cielma Tara , Bandarkar Anjum

Keywords:  Spine Ultrasound, Epidural Hematoma, Lumbar Puncture