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Post Lumbar Puncture Blood Patch Rates With Whitacre Versus Quincke 22 And 20 Gauge Spinal Needles 2007

Interventional Spine

Malcolm Harfield, MD
Jeffrey Willis, PA-C, Non ASSR Member
Stephen Handrich, MD, Non ASSR Member
George Zaleski, MD, Non ASSR Member
Robert Beres, MD, Non ASSR Member

Scientific Paper

Purpose

To compare the incidence of blood patch as the best objective indicator of post dural puncture headache after elective fluoroscopic lumbar puncture (LP) with the use of 22-gauge Whitacre (pencil point) needle versus standard 22 and 20 gauge Quincke (bevel-tip) needles and to determine the best level of puncture.

Methods & Materials

The records of 724 consecutive patients who were referred to St. Mary's Medical Center Department of Radiology for fluoroscopic LP from January 2003 through April 2007 were retrospectively reviewed. Emergency requests (191) were discarded along with patients with clinical signs of pseudo tumor cerebri (21), normal pressure hydrocephalus (3) as well as failed attempts (4). The collective total was 505 elective lumbar punctures.

Results

The blood patch rate for the 22 gauge Whitacre needle was 14/335 or 4.2%. The result for the 22 gauge Quincke point needle was 15.1% while the 20 gauge Quincke point needle was 29.6%. In addition, the level of puncture showed a blood patch rate that increased as the level of lumbar puncture lowered. The highest level of lumbar puncture was L1-2 with the lowest recorded level being L5-S1.

Conclusion

The Whitacre needle is associated with a significantly lower incidence of post lumbar puncture blood patch rate. The highest level of puncture (L1-2) also provides the lowest level of blood patch rate.

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