Table 5.
Factors associated with difficult lumbar punctures and procedural details.
| Factors associated with difficult lumbar puncture |
Patients |
Procedures |
|
|---|---|---|---|
| Factor | Findings | n=33 (%) | n=64 (%) |
| BMIa | BMI < 25 (normal) | 8 (24.2) | 19 (29.7) |
| BMI ≥ 25 (overweight/obese) | 27 (81.8) | 45 (70.3) | |
| Anatomic abnormalities of the lumbar spine | Known abnormalities | 17 (51.5) | 39 (60.9) |
| Spinal stenosis | 12 (36.4) | 35 (54.7) | |
| Arachnoiditis | 4 (12.1) | 9 (14.1) | |
| Postsurgical changes | 2 (6.1) | 2 (3.1) | |
| Scoliosis | 2 (6.1) | 2 (3.1) | |
| Otherb | 4 (12.1) | 9 (14.1) | |
| No known abnormalities | 16 (48.5) | 25 (39.1) | |
| History of previous LPsa | ≥ 5 previous LPs | 11 (33.3) | 25 (39.1) |
| < 5 previous LPs | 14 (42.4) | 32 (50) | |
| Unknown | 8 (24.3) | 7 (10.9) | |
| Age <12 months | Age < 12 months | 3 (9.1) | 4 (6.25) |
| Age > 12 months | 30 (90.9) | 60 (93.8) | |
| History of back surgery | History of back surgery | 3 (9.1) | 3 (4.7) |
| No history of back surgery | 30 (90.9) | 61 (95.3) | |
| Procedural details |
Patients |
Procedures |
|
| Category | Details | N=33 (%) | n=64 (%) |
|
| |||
| Mode of imaging | Fluoroscopy | 31 (93.9) | 60 (93.8) |
| Ultrasound | 2 (6.1) | 4 (6.3) | |
| LP procedure success rate | Successful | 29 (87.9) | 59 (92.2) |
| Unsuccessful | 5 (15.2) | 5 (7.8) | |
| At least one complication | 24 (72.7) | 37 (57.8) | |
| LP procedure complication details | Bloody CSFc | 19 (57.6) | 27 (42.1) |
| Multiple attempts | 11 (33.3) | 16 (25) | |
| Multiple levels | 4 (12.1) | 4 (6.25) | |
| Postprocedure headache | 2 (6.1) | 2 (3.1) | |
Abbreviations: BMI, body mass index; CSF, cerebrospinal fluid; LP, lumbar puncture.
a
As recorded at the time of procedure; two patients had BMIs that varied between < 25 to > 25 among multiple procedures, and four patients had multiple procedures that varied between < 5 or ≥ 5 previous LPs.
b
Epidural hematoma (n = 1), reversal of lumbar lordosis (n = 1), and subdural fluid collection/CSF leak (n = 2).
c
Bloody CSF was defined as > 10 red blood cells per mm3 of CSF.