<b>Lumbar puncture:</b> Anatomical review of a clinical skill

Boon, Jo; Abrahams, Peter; Meiring, J.H.; Welch, T.

doi:10.1002/ca.10250

Cited by 116 publications

(78 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many factors associated with neuraxial anaesthesia have been studied including the structures at the level of the termination of the spinal cord and dural sac [11], vertebral level and shape of the conus medullaris [12], shape of the epidural space [13][14][15], and distance from the skin to the epidural or subarachnoid spaces [16][17][18][19]. However, the effect of body position relevant to neuraxial blockade has not been well studied [20][21][22][23][24], especially in children.…”

Section: Discussionmentioning

confidence: 99%

The effect of flexion on the level of termination of the dural sac in paediatric patients

et al. 2009

View full text Add to dashboard Cite

SummaryAlthough the anatomy of the spinal cord and its associated structures have been well defined, the effects of body position relevant to neuraxial blockade have not been elucidated. This study was designed to determine the effect of body position on the end of the dural sac in children. After induction of anaesthesia, ultrasound examination was performed to evaluate the location of the dural sac end in the lateral position with a straight back and knee, and in the lateral position with the knees, legs, and neck flexed. The level of the end of the dural sac was determined in relation to the vertebrae. Our data demonstrate that the dural sac shifts significantly cephalad in the lateral flexed position used for neuraxial blockade (p < 0.001). These results suggest that the safety margin to avoid dural puncture during hiatal or S2-3 approach for caudal block can be increased in younger children. Dural puncture is a serious technical complication during single-shot caudal block, which is the most common regional technique for postoperative analgesia for paediatric subumbilical surgery. The prevalence of dural puncture associated with caudal analgesia is relatively low. It has only been shown in several case reports [1,2] or at a rate of 1.2% in previous large-scale studies [3,4]. In the study of 760 children, Busoni did not find any case of dural puncture and Dalens [5] reported only one dural puncture in his series of 750 paediatric caudals. Sometimes it is difficult to identify the sacral hiatus and the caudal space due to variations of anatomical structures or obesity. In these cases, a trans-sacral approach to caudal block, described by Busoni [6], may be used as an alternative method. Although no dural puncture was reported in several trans-sacral approach studies [6][7][8], the risk of dural puncture is a possibility. It is known that the end of the dural sac is located at the S4 level just after birth, then ascends to the S2 level as the child grows [9].The anatomy of the spinal cord and its associated structures have been well defined [10], largely based on post-mortem or imaging studies in the supine or prone positions. Many factors associated with neuraxial anaesthesia have been studied including the structures at the level of the termination of the spinal cord and dural sac [11], vertebral level and shape of the conus medullaris [12], shape of the epidural space [13][14][15], and distance from the skin to the epidural or subarachnoid spaces [16][17][18][19]. However, the effect of body position relevant to neuraxial blockade has not been well studied [20][21][22][23][24], especially in children.Ultrasonography, which is a well-established method of investigating the spinal canal, spinal cord, and meningeal coverings in infants and children, has the advantage of being real time, non invasive and safe [25][26][27]. It allows detection of congenital malformations such as myelocele, myelomeningocele, spinal lipoma, dorsal dermal sinus, tight filum terminale syndrome, diastematomyelia, hydromyelia and syri...

show abstract

Section: Discussionmentioning

confidence: 99%

The effect of flexion on the level of termination of the dural sac in paediatric patients

et al. 2009

View full text Add to dashboard Cite

show abstract

“…T he palpation of bony landmarks required to successfully perform lumbar punctures (LPs) 1 can be masked in 33% of overweight patients and 68% of patients with obesity 2 due to overlying soft tissue and can lead to an LP failure rate of 19% 3 without image guidance. Sonography can be helpful for guidance but can only visualize pertinent bony landmarks in patients with obesity 74% of the time.…”

mentioning

confidence: 99%

Using Body Mass Index to Predict Needle Length in Fluoroscopy-Guided Lumbar Punctures

Nayate

Nasrallah

Schmitt

et al. 2015

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…Other complications, including headaches lasting from 8 days to 1 year, cranial neuropathies, continued backache, nerve root injury, and meningitis, are rare, following less than 1% of lumbar punctures [117]. In addition to these side effects, lumbar puncture is a complicated [118] and expensive procedure so other alternatives such as peripheral blood could be of interest in the search of biomarkers related to AD.…”

Section: Metabolomics and Ad In Plasma And Serummentioning

confidence: 99%

Metabolomics in the Study of Alzheimer's Disease

Ibáñez

Valdés

García‐Cañas

et al. 2014

Comprehensive Analytical Chemistry

View full text Add to dashboard Cite

With an increasing aging population, Alzheimer's disease (AD) has become a social and economic problem to societies worldwide, affecting millions of people. However, pathophysiological events associated with AD are not well elucidated yet and current definitive diagnosis is only obtained after death through examination of brain tissue. In the last years, Metabolomics has been demonstrated to provide deep insights into the full complexity of the disease phenotype and has been established as a promising approach to provide disease-specific metabolite signatures. The incipient application of Metabolomics may potentially contribute in the elucidation of AD physiopathological processes and ideally may offer therapeutic/preventing mechanisms to slow or reverse AD progress. In this chapter non-targeted metabolomics approaches applied to AD investigation are described.

show abstract

Lumbar puncture: Anatomical review of a clinical skill

Cited by 116 publications

References 44 publications

The effect of flexion on the level of termination of the dural sac in paediatric patients

The effect of flexion on the level of termination of the dural sac in paediatric patients

Using Body Mass Index to Predict Needle Length in Fluoroscopy-Guided Lumbar Punctures

Metabolomics in the Study of Alzheimer's Disease

Contact Info

Product

Resources

About