Abstract
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.
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Jeffrey Forris Beecham Chick is a consultant and speaker for Guerbet and C. R. Bard. Eric J. Monroe is a scientific advisor and speaker for Biogen.
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Jeyakumar, A., Weaver, J.J., Chick, J.F.B. et al. Spinal ultrasound after failed landmarked-based lumbar puncture: a single institutional experience. Pediatr Radiol 51, 289–295 (2021). https://doi.org/10.1007/s00247-020-04831-w
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DOI: https://doi.org/10.1007/s00247-020-04831-w