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Spinal Puncture: From Bedside to Interventional Suite 2008

Interventional Spine

Jason G Beck, MD,
George Luh, MD, ASSR Member

Scientific Poster

Exhibit Panels: 1

Purpose

With the growing epidemic of obesity and spine disease associated with it, as well as the aging population, the traditionally bedside lumbar puncture can frequently be technically demanding. As a result there is an increasing reliability by clinicians on the radiologist to perform diagnostic and therapeutic spinal punctures under image guidance. The objective of this presentation is to review various techniques employed in imaged guided spinal puncture as well as discuss the indications, complications, and ways to minimize those complications. This presentation will also look at pitfalls in assessing opening pressure along with new methods for obtaining pressure measurements.

Methods & Materials

KEY LEARNING POINTS:

1. Anatomic review of various techniques in image guided spinal puncture.
2. Assessing patients for spine disease and predicting technical success prior to lumbar puncture.
3. Discuss advantages and limitations of various modalities used in image guided spinal puncture.
4. Traditional and new methods for obtaining opening pressures and pitfalls related to patient positioning.
5. Indications for and complications related to cerebrospinal fluid sampling.
6. Minimum volume required for common cerebrospinal fluid tests.
7. Techniques for minimizing complications during and post lumbar puncture.
8. Needle type and size and the associated risk of cerebrospinal fluid leak.
9. Management of post lumbar puncture headache.

References

1. Lavi, R. et al. Traumatic vs. atraumatic 22 G needle for therapeutic and diagnostic lumbar puncture in the hematologic patient: a prospective clinical trial.
Haematologica. 2007 Jul;92(7):1007-8.

2. Shah, KH. et al. Predicting difficult and traumatic lumbar punctures.
Am J Emerg Med. 2007 Jul;25(6):608-11.

3. Lee, LC. et al. Prevention and management of post-lumbar puncture headache in pediatric oncology patients. J Pediatr Oncol Nurs. 2007 Jul-Aug;24(4):200-7.

4. Stiffler, KA. et al. The use of ultrasound to identify pertinent landmarks for lumbar puncture. Am J Emerg Med. 2007 Mar;25(3):331-4.

5. Johnson, JC. et al. Coaxial needle technique for lumbar puncture in the morbidly obese patient. Radiology. 1991 Jun;179(3):874.

6. Molina, A. et al. Factors associated with lumbar puncture success.
Pediatrics. 2006 Aug;118(2):842-4;

7. Lambert, DH. et al. Role of needle gauge and tip configuration in the production of lumbar puncture headache. Reg Anesth. 1997 Jan-Feb;22(1):66-72.

8. Pheiffer, BM. et al. Measuring opening pressure in lumbar puncture--a new method]
Biomed Tech (Berl). 2003 Apr;48(4):86-9.

9. Abbrescia KL, et al. The effect of lower-extremity position on cerebrospinal fluid pressures. Acad Emergency Med. 2001 Jan;8(1):8-12.

10. Boon, JM. et al. Lumbar puncture: anatomical review of a clinical skill.
Clin Anat. 2004 Oct;17(7):544-53.