Journal of pediatric orthopedics. Part B
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This study describes a new procedure for a safer and easier access for the intrathecal injection of the recently approved nusinersen therapy in spinal muscular atrophy. This therapy changed the natural history of the disease, but, to date, scoliosis surgery was an excluding criteria for nusinersen therapy. The bone mass, due to the posterior spinal fusion of the scoliosis surgery, prevents the needle for the nusinersen administration from intervertebral access. ⋯ Two patients underwent PSF after the nusinersen therapy was available. All of them underwent a laminotomy with a fat grafting at the L3-L4 laminotomy level and received nusinersen therapy without complications. The procedure described is simple and effective in providing safe intrathecal access to make these patients eligible for such important therapy.
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The aim of this study was to evaluate whether short-term positive effects on bimanual function after surgery of the paretic arm in cerebral palsy are maintained long term. Assisting Hand Assessment (AHA) and active range of motion was tested before surgery and at 7 month and 9-year follow-up (n=18). ⋯ Surgery of wrist and elbow flexors significantly improved active extension. Improvement in wrist and elbow extension was maintained at the 9-year follow-up, but usefulness of the hand measured with AHA had returned to the same level as before surgery.