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Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches.

P A Hudgins1, A J Fountain2, P R Chapman3

  • 1From the Department of Radiology and Imaging Sciences (P.A.H., A.J.F.), Division of Neuroradiology, Emory University School of Medicine, Atlanta, Georgia phudgin@emory.edu.

AJNR. American Journal of Neuroradiology
|March 18, 2017
PubMed
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Radiologists increasingly perform lumbar punctures, especially in obese patients, using fluoroscopic guidance. This review details techniques and tips for performing lumbar punctures effectively in challenging cases, particularly for trainees.

Area of Science:

  • Radiology
  • Medical Procedures

Background:

  • Lumbar puncture traditionally performed by internal medicine physicians and neurologists.
  • Increasing prevalence of spine surgery and rising obesity rates necessitate radiologist involvement.
  • Radiologists are now the primary providers of lumbar puncture procedures, often using fluoroscopic guidance.

Purpose of the Study:

  • To describe techniques for performing lumbar puncture in difficult cases, focusing on obese patients.
  • To provide tips and maneuvers to facilitate lumbar puncture with fluoroscopic guidance in obese individuals.
  • To share practical experience for trainees early in their careers.

Main Methods:

  • Review of techniques for lumbar puncture in challenging patient populations.
  • Emphasis on fluoroscopic guidance for obese patients.

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  • Description of specific maneuvers to improve visualization and needle placement.

    • Main Results:

    • Fluoroscopic guidance presents challenges in obese patients due to increased subcutaneous fat obscuring landmarks.
    • Specific techniques and maneuvers can enhance the success rate of lumbar puncture in obese patients.
    • The review synthesizes practical experience for proceduralists.

    Conclusions:

    • Radiologists play a key role in performing lumbar punctures, particularly in obese patients.
    • Effective techniques and maneuvers are crucial for successful fluoroscopically guided lumbar puncture in challenging cases.
    • This review offers valuable insights for training and practice in interventional radiology.