PMC9082934_01
Scoliosis orthopedic surgery. X-ray, CT images and appearance of the SMA patient with scoliosis. (A) The anteroposterior view of spinal X-ray before surgery. (B) The lateral view of spinal X-ray before surgery. (C,D) The left and right bending view of spinal X-ray before surgery. (E,F) The three-dimensional CT images before surgery. (G) The anteroposterior view of spinal X-ray after surgery. (H) The lateral view of spinal X-ray after surgery. (I) The appearance of the back before surgery. (J) The appearance of the back after surgery. (K) The three-dimensional CT images after surgery. (L) The sagittal CT images after surgery and the osseous channel are circled in the figure.
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F1
Pelvic inclination angle improved from 9.5  (preoperative) to 0.5  (postoperative) and pelvic tilt was well-corrected (Figure 1).
Nusinersen intrathecal injection process under the guidance of B-ultrasound and CT. (A,B) Real-time ultrasound-guided lumbar puncture. (A) Ultrasound probe position of paramedian sagittal oblique scan at the level of lamina. (B) Local anesthesia before intrathecal injection. C-E CT-guided lumbar puncture. (C) Place a metal positioning wire at the posterior midline around the lumbar spine. (D) Determine the needle insertion route through CT scan, and calculate the needle insertion point on the body surface and needle insertion angle. (E) The puncture needle successfully entered the subarachnoid space).
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F2
Lumbar punctures were successfully performed with local anesthesia under real-time ultrasound guidance through the laminae channel for the first and second Nusinersen injections (Figures 2A,B), although it was time-consuming to find the anatomical structure in which echo signal was affected by the postoperative local anatomical changes and implants. Considering the comfort and minimization of tissue injury to the patient, lumbar puncture was guided with the help of CT for the third and fourth dosage of Nusinersen (Figures 2C-E).