JOURNAL CLUB: Incidence of Complications Following Fluoroscopically Guided Lumbar Punctures and Myelograms

Rodríguez, David Avelar; Branstetter, Barton F.; Agarwal, Vikas; Palfey, Stacie; Ching, Kevin C.; Bump, Gregory M.; Hughes, Marion A.

doi:10.2214/ajr.15.14664

Cited by 28 publications

(34 citation statements)

References 14 publications

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“…While our post-LP headache rate was higher compared with the study of Rodriguez et al 24 (which contained a higher number of healthy patients), our complication rate with TFLP was lower than that for interlaminar LP compared with the study by Haché et al (containing only patients with SMA). 11,24 While there is evidence that cutting needles, such as the Quincke needles used in our study, lead to a higher rate of post-LP headache, the rate of headache requiring an epidural blood patch is not significantly different between the Quincke needle and nontraumatic needles. 26,27 The study by Rodriguez et al 24 demonstrated that it is possible to obtain a very low rate of headache despite using Quincke needles.…”

Section: Safetycontrasting

confidence: 82%

“…23 Younger age and female sex have been identified as significant risk factors, and these patients are more likely to receive an epidural blood patch. 23,24 The incidence of post-LP headache varies between 2.2% and 32% with different techniques and instrumentation. [23][24][25] Rodriguez et al 24 reported post-LP headache in 2.2% of 2141 patients who underwent fluoroscopy-guided lumbar puncture using either a 22-or 25-ga Quincke needle.…”

Section: Safetymentioning

confidence: 99%

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Transforaminal Lumbar Puncture: An Alternative Technique in Patients with Challenging Access

Nascene

Özütemiz

Estby

et al. 2018

AJNR Am J Neuroradiol

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Interlaminar lumbar puncture and cervical puncture may not be ideal in all circumstances. Recently, we have used a transforaminal approach in selected situations. Between May 2016 and December 2017, twenty-six transforaminal lumbar punctures were performed in 9 patients (25 CT-guided, 1 fluoroscopy-guided). Seven had spinal muscular atrophy and were referred for intrathecal nusinersen administration. In 2, CT myelography was performed via transforaminal lumbar puncture. The lumbar posterior elements were completely fused in 8, and there was an overlying abscess in 1. The L1-2 level was used in 2; the L2-3 level, in 10; the L3-4 level, in 12; and the L4-5 level, in 2 procedures. Post-lumbar puncture headache was observed on 4 occasions, which resolved without blood patching. One patient felt heat and pain at the injection site that resolved spontaneously within hours. One patient had radicular pain that resolved with conservative treatment. Transforaminal lumbar puncture may become an effective alternative to classic interlaminar lumbar puncture or cervical puncture.

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Section: Safetycontrasting

confidence: 82%

Section: Safetymentioning

confidence: 99%

Transforaminal Lumbar Puncture: An Alternative Technique in Patients with Challenging Access

Nascene

Özütemiz

Estby

et al. 2018

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…Twenty‐eight studies, published between 1970 and 2016 (references in this paragraph resulted from the systematic literature review, Table 3), compared the performance and complications of different diameters of needles. No differences were detected in six studies comparing different needle diameters [47–52], whereas one study concluded that needles with a larger diameter (≤22G) had a positive effect on collection time and resulted in less failures [53]. The LP feasibility study performed in memory clinic settings did not show that large‐bore diameter needles confer independent risk compared with small bore needle types.…”

Section: Resultsmentioning

confidence: 97%

Consensus guidelines for lumbar puncture in patients with neurological diseases

Engelborghs

Niemantsverdriet

Struyfs

et al. 2017

Alz & Dem Diag Ass & Dis Mo

262

280

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IntroductionCerebrospinal fluid collection by lumbar puncture (LP) is performed in the diagnostic workup of several neurological brain diseases. Reluctance to perform the procedure is among others due to a lack of standards and guidelines to minimize the risk of complications, such as post-LP headache or back pain.MethodsWe provide consensus guidelines for the LP procedure to minimize the risk of complications. The recommendations are based on (1) data from a large multicenter LP feasibility study (evidence level II-2), (2) systematic literature review on LP needle characteristics and post-LP complications (evidence level II-2), (3) discussion of best practice within the Joint Programme Neurodegenerative Disease Research Biomarkers for Alzheimer's disease and Parkinson's Disease and Biomarkers for Multiple Sclerosis consortia (evidence level III).ResultsOur consensus guidelines address contraindications, as well as patient-related and procedure-related risk factors that can influence the development of post-LP complications.DiscussionWhen an LP is performed correctly, the procedure is well tolerated and accepted with a low complication rate.

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“…Acutely, the most common manifestation of accidental puncture of the CM is patient headache (Cauley, 2015;Rodriguez et al, 2016). Several other clinical stigmata include foot drop, urinary symptoms (Reynolds, 2001;Ahmad et al, 2006), or fasciculations, tremors, pain, and parasthesias in the setting of cauda equina or CM syndrome (Melloni et al, 2015).…”

Section: Accidental Needle Puncture and Damage Of The CMmentioning

confidence: 99%

Are high lumbar punctures safe? A magnetic resonance imaging morphometric study of the conus medullaris

et al. 2019

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A high lumbar puncture (LP) at L2–L3 or above is often necessary to consider on technical grounds, but complications of conus medullaris (CM) damage during high LP are potentially concerning. We hypothesized that a high LP might be safer than previously thought by accounting for movements of the CM upon patient positional changes. We retrospectively reviewed standard normal supine lumbar spine magnetic resonance imaging of 58 patients and used electronic calipers on axial images at the T12–L1, L1–L2, and L2–L3 disc levels to measure the transverse diameter of the CM relative to the size of the dorsal thecal sac space (DTSS) through which a spinal needle could be inserted. On 142 axial images, the means for CM diameters were 8.2, 6.0, and 2.9 mm at the three levels, respectively. We then used known literature mean CM displacement values in the legs flexed and unflexed lateral decubitus position (LDP) to factor in CM shifts to the dependent side. We found that at all three levels, the likely positional shift of the CM would be too small and insufficient to displace the entire CM out of the DTSS. However, if needle placement could be confined to the midsagittal plane, an LP in the unflexed LDP would theoretically be entirely safe at both L1–L2 and L2–L3, and almost so at L2–L3 in the legs flexed LDP. Thus, high LPs at L1–L2 and L2–L3 are in theory likely safer than considered previously, more so in the legs unflexed than in the flexed LDP. Clin. Anat. 32:618–629, 2019. © 2019 Wiley Periodicals, Inc.

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JOURNAL CLUB: Incidence of Complications Following Fluoroscopically Guided Lumbar Punctures and Myelograms

Abstract: Fluoroscopically guided dural punctures result in few complications compared with lumbar punctures performed without fluoroscopic guidance. Postprocedural bed rest greater than 2 hours does not reduce complication rates for fluoroscopically guided lumbar punctures.

Cited by 28 publications

References 14 publications

Transforaminal Lumbar Puncture: An Alternative Technique in Patients with Challenging Access

Transforaminal Lumbar Puncture: An Alternative Technique in Patients with Challenging Access

Consensus guidelines for lumbar puncture in patients with neurological diseases

Are high lumbar punctures safe? A magnetic resonance imaging morphometric study of the conus medullaris

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