Rates of Epidural Blood Patch following Lumbar Puncture Comparing Atraumatic versus Bevel-Tip Needles Stratified for Body Mass Index

Abstract

BACKGROUND AND PURPOSE: Postdural puncture headache, a known complication of lumbar puncture, typically resolves with conservative management. Symptoms persist in a minority of patients, necessitating an epidural blood patch. One method of decreasing rates of postdural puncture headache is using atraumatic, pencil-point needles rather than bevel-tip needles. To the best of our knowledge, this is the first study comparing epidural blood patch rates between pencil-and bevel-tip needles with a subgroup analysis based on body mass index.

Regarding “Rates of Epidural Blood Patch following Lumbar Puncture Comparing Atraumatic versus Bevel-Tip Needles Stratified for Body Mass Index”

“…It is unclear to us why our rate of postprocedural EBP is substantially lower than that recorded by Philip et al 1 This rate may reflect differences in technique, patient population, or operator expertise. The work by Philip et al is interesting, but firm conclusions regarding the relative advantages of needle type in fLP should be based on literature that controls for patient characteristics such as age and sex as well as operator characteristics such as experience.…”

“…Young age and female sex are predisposing factors for positional headaches following lumbar puncture, as confirmed in our study. 2 No data were provided in the article by Philip et al 1 regarding the age and sex of patients. There might be a higher percentage of young women among the patients treated with Quincke needles or among their patient population overall compared with our cohort.…”

Reply:

“…One of the main limitations of our study is that the lumbar punctures (LPs) were performed by a variety of radiologists with variable levels of experience, including trainees. 1 While this feature introduces potential confounding variables, we believe it is more indicative of how LPs are performed in most radiology departments; thus, it is a more accurate estimation of post-dural puncture headaches (PDPHs) necessitating an epidural blood patch (EBP). The number of LPs performed in radiology has been increasing.…”