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Spinal ultrasound after failed landmarked-based lumbar puncture: a single institutional experience
Arthie Jeyakumar1, John J Weaver1, Jeffrey Forris Beecham Chick1,2
1Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA.
Insights
Pre-procedure ultrasound (US) enhances the safety and success of lumbar punctures in children. This imaging technique helps identify complications and select appropriate candidates for the procedure, improving outcomes.
Area of Science:
- Pediatric Radiology
- Medical Imaging Techniques
- Interventional Procedures
Background:
- Lumbar puncture (LP) in children is often performed after failed landmark-based attempts.
- Ultrasound (US) can guide lumbar puncture, improving subarachnoid access and success rates.
- Routine pre-procedure US is valuable in the pediatric setting.
Purpose of the Study:
- To evaluate the impact of pre-procedure ultrasound on the technical success and safety of US-guided lumbar puncture in pediatric patients.
- To determine if routine pre-procedure US improves outcomes for pediatric lumbar punctures.
Main Methods:
- A cohort of 47 pediatric patients (<18 years) undergoing urgent US-guided lumbar puncture was studied.
- Inclusion criteria focused on urgent procedures, excluding non-urgent cases or those without prior landmark attempts.
- Data collected included technical success rates, adverse events, and abnormalities identified by pre-procedural US.
Main Results:
- Thirty-six US-guided lumbar punctures achieved 100% technical success.
- Eleven children did not undergo LP due to US findings or clinical improvement.
- Pre-procedural US identified complications like paucity of cerebrospinal fluid (12/36) and epidural hematoma (14/36); 15 traumatic taps (mild adverse events) occurred, with no moderate/severe events.
Conclusions:
- Limited spinal ultrasound effectively identifies complications after failed landmark-based lumbar punctures.
- Pre-procedure US can improve patient selection for subsequent image-guided lumbar punctures.
- Ultrasound guidance enhances the safety and efficacy of lumbar puncture in pediatric patients.
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.
