Intrathecal injection via ultrasound localization provides new hope for children with SMA complicated with severe spinal malformation

2022-06-05 0 By

This article is from:Yangzi evening news yangzi evening news network – March 29 (trainee journalist Lv Yanlin correspondent Zhang Yixuan) recently, the nanjing children’s hospital emergency/intensive medicine, anesthesiology, orthopaedic joint and smooth for a 14-year-old spinal muscular atrophy (SMA) sex with severe spinal deformity implementation of NSN that children born under the ultrasound-guided localization of sodium intrathecal injection treatment.The realization of this technology will bring the hope of medication for more SMA children with severe spinal deformity.Yang Yang (pseudonym) was diagnosed with spinal muscular atrophy (SMA) at the age of one. “It was 2009, and there was no medicine, so we just watched it get worse,” her mother told reporters.Limbs muscle atrophy gradually, motion ability decreases, muscle weakness aggravates progressively.There is no specific medicine, the family can only take Yangyang to do some symptomatic rehabilitation treatment regularly.With the aggravation of his condition, he could not walk, stand or sit alone. Due to severe scoliosis of the spine, his torso needed orthopaedic support when sitting, and he could only rely on a wheelchair to move.Finally, in 2016, the first SMA treatment drug Nosinasan sodium injection was approved in foreign countries, introduced into China in 2019, on December 3, 2021 officially included in China’s resident medical insurance.The news brought hope to Yang Yang.At the beginning of this year, yangyang’s family came to Nanjing Children’s Hospital with the plan to start noxinacan sodium treatment.But Yangyang’s medication is not as simple as imagined.Qin Zhang, deputy chief physician of the Department of Emergency/Critical Care Medicine, said, “Noxinacan sodium needs to be injected intrathecally, which is delivered into the spinal canal through the lumbar l3-4 or L4-5 space.This significantly increases the difficulty of intrathecal injection in children with severe scoliosis, making successful lumbar puncture the biggest challenge.”After Yang Yang was hospitalized, experts from the department of emergency/intensive care medicine, the department of anesthesiology and orthopaedic department held multiple multidisciplinary discussions on Yang Yang’s condition, focusing on how to accurately implement intrathecal injection in complex and severe scoliosis.The Cobb Angle of Yangyang scoliosis was more than 80 degrees, and the most serious part of thoracolumbar body rotation was more than 60 degrees.Wang Fei, deputy chief orthopedic surgeon, said: “This degree of lateral bending is very serious, just like a twisted towel.Moreover, due to long-term bed rest, the shape of the lumbar spine was changed, and the intervertebral space was only half of that of ordinary people.In this case, it is difficult to accurately control the choice of insertion position, left-right pitch Angle, and insertion depth, thus achieving intrathecal administration is very difficult.””If the puncture is too far or too deep, it may damage the surrounding blood vessels and nerves,” added Zhong Shan, chief anesthesiology doctor.After full multidisciplinary discussion and evaluation, the hospital determined the plan of lumbar puncture intrathecal injection guided by ultrasound under local anesthesia.Department of Anesthesiology Director Zhong Shan led the team to perform puncture, emergency/intensive care medicine and orthopedic assistance.Director Zhong Shan said: “For severe scoliosis and rotation of the difficult puncture, through the orthopaedic precise spine bending and rotation measurement, at the same time the use of ultrasound visualization advantages for accurate positioning, determine the needle position and needle Angle, is beneficial to the successful completion of our lumbar puncture.”Meanwhile, due to the large scoliosis Angle in yangyang, the patient was finally punctured in the sitting position, and the needle was inserted at 45 degrees above the puncture point to complete intrathecal injection of Noxinacan sodium.With the cooperation of the three departments, Yang Yang finally used SMA drugs 13 years after her diagnosis.When Nosinasan sodium was just introduced into China, it required three to six injections every year, and the drug was used for life. The sky-high treatment cost made many families shy away.Now the cost is reduced to 33,000 yuan per injection and can be reimbursed twice according to local medical insurance policies, making it possible for ordinary families to take the medicine.For SMA children and their families, there is too much physical and psychological pain, zhang said.”As a third class a specialized children’s hospital, we should assume the responsibility of allowing more children to use medicine as early as possible, so that they sit up, stand up and walk up earlier.”Proofreading by Li Haihui source: Purple Cow News