Spinal ultrasound after failed landmarked-based lumbar puncture: a single institutional experience

BACKGROUND

The safety and efficacy of US-guided lumbar puncture in children has been described. In the pediatric setting, children are frequently referred to interventional radiology only after a failed landmark-based attempt. Routine pre-procedure US in these children is useful to determine a safe level for subarachnoid access and to optimize success.

OBJECTIVE

To determine whether pre-procedure US improves technical success and safety of US-guided lumbar puncture.

MATERIALS AND METHODS

We included 47 children. Inclusion criteria were urgent US-guided lumbar puncture in pediatric patients <18 years old. Exclusion criteria were non-urgent lumbar punctures, children referred without an antecedent landmark-based attempt, lumbar punctures performed with fluoroscopic guidance, and procedures performed prior to introducing the diagnostic approach in 2017. We did not evaluate data pertaining to successful landmark-based lumbar punctures performed without subsequent need for additional attempts. We recorded technical successes, adverse events and relevant abnormalities identified on pre-procedural US.

RESULTS

Thirty-six US-guided lumbar punctures were performed with 100% technical success. Eleven children referred to interventional radiology did not undergo lumbar puncture because of unfavorable US findings or interval clinical improvement obviating the need for lumbar puncture. Thirty-six children underwent US evaluation of the thecal sac prior to potential intervention. Of these 36 with pre-procedural US studies, 12 demonstrated paucity of cerebrospinal fluid and 14 demonstrated an epidural hematoma. Fifteen children who underwent lumbar puncture had a "traumatic tap," classified as a mild adverse event. No moderate or severe adverse events were recorded.

CONCLUSION

Limited spinal US following failed landmark-based lumbar punctures frequently identifies procedure-related complications and can augment patient selection for future image-guided lumbar punctures.

Success rate of elective lumbar puncture at a major Melbourne neurology unit

Background:

Lumbar puncture remains an important diagnostic and therapeutic procedure in clinical neurology. Failed lumbar punctures can result in a delay in diagnosis. Ultrasound may have a role in increasing successful lumbar puncture rates.

Methods:

Data was collected retrospectively from patient notes who had an elective lumbar puncture from January 2012 to August 2015.

Results:

During this four-year period, 74 patients underwent a neurologic outpatient lumbar puncture. Of these 74 lumbar punctures, 53 were successful (28% failure rate).

Conclusions:

This study found a 28% failure rate of conventional palpation-guided lumbar puncture. Ultrasound may provide an exciting opportunity to optimize lumbar puncture procedures and improve patient experience and diagnostic outcomes.