Neurological deterioration after lumbar puncture below complete spinal subarachnoid block.

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Complete spinal subarachnoid block is a serious condition.
• Cerebrospinal fluid removal below a complete block is generally accepted to carry neurological risks.
• The precise incidence of neurological deterioration following lumbar puncture in the presence of a complete block is not well-established.

Purpose of the Study:

• To determine the incidence of neurological deterioration after lumbar puncture in patients with a complete spinal subarachnoid block.
• To compare the risk of neurological deterioration between lumbar puncture and C1-2 puncture in this patient population.

Main Methods:

• Retrospective case analysis of 100 patients with complete spinal subarachnoid block confirmed by myelography.
• Patients were divided into two groups: 50 who underwent lumbar puncture and 50 who underwent C1-2 puncture.
• Groups were matched for age, pre-myelography neurological status, block level, and disease nature.

Main Results:

• Seven out of 50 patients (14%) who underwent lumbar puncture experienced significant neurological deterioration.
• No neurological deterioration was observed in the 50 patients who underwent C1-2 puncture.
• The study identified a minimum risk of 14% for downward spinal coning after lumbar puncture below a complete spinal subarachnoid block due to a mass lesion.

Conclusions:

• Lumbar puncture below a complete spinal subarachnoid block carries a significant risk of neurological deterioration, estimated at least 14%.
• C1-2 puncture appears to be a safer alternative, with no observed deterioration in this study.
• These findings underscore the importance of considering the risks of lumbar puncture in patients with complete spinal blocks and suggest alternative approaches may be preferable.