Lumbar punction: comparison between an atraumatic and a traumatic punction needle
Background: Lumbar puncture is a standardized, routine diagnostic procedure in the diagnosis of neurological diseases. Post-duarl puncture headache (PDPH) is a common complication which occurs in 10 to 30 % of patients. Although the incidence of PDPH is much lower with the use of small, non-cutting needles, neurologists in Slovenia routinely use the classical traumatic spinal needles.
Methods: In the article we provide an overview of a research concerned with the use of traumatic and atraumatic needles in the procedure with the emphasis on complications of the lumbar puncture. We present American and European recommendations for lumbar puncture procedure.
Conclusions: International recommendations for neurologists advise the use of atraumatic spinal needles for lumbar puncture. We recommend to Slovenian neurologists to start using the atraumatic needles for elective lumbar punctures and hence provide neurological patients with better quality and cheaper long-term care.
Armstrong S. How to perform a lumbar puncture. Br J Hosp Med(Lond). 2010;71(6):M36-8.
Wynter WE. Four Cases of Tubercular Meningitis in Which Paracentesis of the Teca Vertebralis Was Performed for the Relief of Fluid Pressure. Lancet. 1891;1 (3531):981–2.
Quincke HI. Verhandlungen des Congresses für Innere Medizin. Wiesbaden: Zenther Congress; 1891. p. 321–31.
Quincke HI. Die Lumbarpunktion des Hydrocephalus. Klin Wochenschr. 1891;28:965.
Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. 2001;345(24):1727–33.
Kneen R, Solomon T, Appleton R. Te role of lumbar puncture in suspected CNS infection—a disappearing skill? ArchDis Child. 2002;87(3):181–3.
Choi S, Brull R. Neuraxial techniques in obstetric and non-obstetric patients with common bleeding diatheses. Anesth Analg. 2009;109(2):648–60.
van Veen JJ, Nokes TJ, Makris M. Te risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. Br J Haematol. 2010;148:15–25.
Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000;23(4):175–204.
Euerle BD. Chapter 60–Spinal puncture and cerebrospinal ﬂuid examination. In: Roberts JR, ed. Roberts and Hedges’ Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia: Elsevier Saunders; 2014. p. 1218–1242.e3.
Ruﬀ RL, Dougherty JH Jr. Complications of lumbar puncture followed by anticoagulation. Stroke. 1981;12(6):879–881.
Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: Part I diagnosis, epidemiology, etiology, and pathophysiology. Headache. 2010;50 (7):1144–52.
Wang LP, Schmidt JF. Central nervous side eﬀects afer lumbar puncture. A review of the possible pathogenesis of the syndrome of postdural puncture headache and associated symptoms. Dan med bull. 1997;44(1):79–81.
Racz GB, Noe CE, ed. Pain and treatment. Chapter 7. Wang F. Post Dural Puncture Headache – We Can Prevent It. Rijeka: In tech; 2014. p. 204–241. Available from: http://www.intechopen.com/books/pain-and-treatment/post-dural-puncture-headache-we-can-prevent-it.
Headache Classifcation Subcommittee of the International Headache Society. The international classifcation of headache disorders: 2nd edition. Cephalalgia. 2004, 24 Suppl 1:9–160.
Strupp M, Schueler O, Straube A, Von Stuckrad-Barre S, Brandt T. Atraumatic Sprotte needle reduces the incidence of post-lumbar puncture headaches. Neurology. 2001;57 (12):2310–2.
Lavi R, Yarnitsky D, Rowe JM, Weissman A, Segal D, Avivi I. Standard vs atraumatic Whitacre needle for diagnostic lumbar puncture: a randomized trial. Neurology. 2006;67 (8):1492–4.
Hammond ER, Wang Z, Bhulani N, McArthur JC, Levy M. Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic. J Neurol Sci. 2011;306 (1–2):24–8.
Demaerschalk BM, Wingerchuk DM. Atraumatic dural puncture needles for preventing post-dural puncture headache: meta-analysis of randomized controlled trials. Neurology. 2002;58 Suppl 3):A285–6.
Tomas SR, Jamieson DR, Muir KW. Randomised controlled trial of atraumatic versus standard needles for diagnostic lumbar puncture. BMJ. 2000;321 (7267):986–90.
Hatfeld MK, Handrich SJ, Willis JA, Beres RA, Zaleski GX. Blood patch rates afer lumbar puncture with Whitacre versus Quincke 22- and 20-gauge spinal needles. Am J Roentgenol. 2008;190(6):1686–9.
Lybecker H, Moller JT, May O, Nielsen HK. Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. Anesth Analg. 1990;70 (4):389–94.
Kuntz KM, Kokmen E, Stevens JC, Miller P, Oﬀord KP, Ho MM. Post-lumbar puncture headaches: experience in 501 consecutive procedures. Neurology. 1992;42 (10):1884–7.
Dakka Y, Warra N, Albadareen RJ, Jankowski M, Silver B.Headache rate and cost of care following lumbar puncture at a single tertiary care hospital. Neurology. 2011;77 (1):71–4.
Arendt K, Demaerschalk BM, Wingerchuk DM, Camann W. Atraumatic lumbar puncture needles: afer all these years, are we still missing the point? Neurologist. 2009;15 (1):17–20.
Menéndez-González M. Routine lumbar puncture for the early diagnosis of Alzheimer’s disease. Is it safe? Front Aging Neurosci. 2014;6 (65):1–2.
Evans RW, Armon C, Frohman EM, Goodin DS. Assessment: prevention of post-lumbar puncture headaches: report of the therapeutics and technology assessment subcommittee of the American academy of neurology. Neurology. 2000;55(7):909–14.
Peskind E, Nordberg A, Darreh-Shori T, Soininen H. Safety of lumbar puncture procedures in patients with Alzheimer’s disease. Curr Alzheimer Res. 2009;6:290–2.
Birnbach DJ, Kuroda MM, Sternman D, Tys DM. Use of atraumatic spinal needles among neurologists in the United States. Headache. 2001;41 (4):385–90.
Serpell MG, Haldane GJ, Jamieson DR, Carson D. Prevention of headache afer lumbar puncture: questionnaire survey of neurologists and neurosurgeons in United Kingdom. BMJ. 1998;316 (7146):1709–10.
Armon C, Evans RW. Addendum to assessment: Prevention of post–lumbar puncture headaches Report of the Terapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005;65:510–2.
Natioanal statistics: Hospital Episode Statistics, Admitted Patient Care 2012–13. Health and Social Care Information Centre; 2013. p. 1–42. Available from: http://www.gov.uk.
Engedal TS, Oerding H, Vilholma OJ. Changing the needle for lumbar punctures. Results from a prospective study. Clin Neurol Neurosurg. 2015;130:74–9.
Laboratorijski informacijski sistem. Laboratorij za likvorsko diagnostiko, Klinični oddelek za bolezni živčevja, Nevrološka klinika, UKC Ljubljana. (Osebno sporočilo dr. Uroš Rot, 27.7.2016).
German Healthcare Export Group (GHE). Spinocan®, Pencan®, Atraucan® – Needles for spinal anesthesia, diagnostic lumbar puncture and cytologic biopsies [cited 2016 Jun 2]. Available from: https://www.gheg.de/en/products/spinocan-pencan-atraucan-needles-for-spinal-anesthesia-diagnostic-lumbar-puncture-and-cytologic-biopsies/.
Doherty CM, Forbes RB. Diagnostic Lumbar Puncture. Ulster Med J. 2014;83(2):93–102.
Vakharia VN, Lote H. Introduction of Sprotte needles to a single-centre acute neurology service: before and afer study. RSM Short Rep. 2012;3(82):1–5.
Davis A, Dobson R, Kaninia S, Espasandin M, Berg A, Giovannoni A, et al. Change practice now! Using atraumatic needles to prevent post lumbar puncture headache. EJN. 2014;21 (2):305–11.
Carson D, Serpell M. Choosing the best needle for diagnostic lumbar puncture. Neurology. 1996;47(1):33–7.
Tourtellotte WW, Henderson WG, Tucker RP, Gilland O, Walker JE, Kokeman E. A randomized double-blind clinical trial comparing the 22 versus 26 gauge needle in the production of the post-lumbar puncture syndrome in normal individuals. Headache 1972;12:73–8.
Straus, SE, Torpe, KE, Holroyd-Leduc J. How Do I Perform a Lumbar Puncture and Analyze the Results to Diagnose Bacterial Meningitis? JAMA. 2006;296(16):2012–22.
Braune HJ, Huﬀman GA. A prospective double-blind clinical trial, comparing the sharp Quinke needle (22G) with an “atraumatic” needle (22G) in the introduction of post-lumbar puncture headache. Acta Neurol Scand. 1992;86(1):50–4.
Duits FH, Martinez-Lage P, Paquet C, Engelborghs S, Lleo A, Hausner L, et al. Performance and complications of lumbar puncture in memory clinics: Results of the multicenter lumbar puncture feasibility study. Alzheimer’s and Dementia. 2016;12 (2):154–63.
Jager H, Krane M, Schimrigk K. [Lumbar puncture—the post-puncture syndrome. Prevention with an “atraumatic” puncture needle. Clinical observations]. Schweiz Med Wochenschr. 1993;123(42):1985–90.
Kleyweg RP, Hertzberger LI, Carbaat PA. Signifcant reduction in post lumbar puncture headache using an atraumatic needle. A double-blind, controlled clinical trial. Cephalalgia. 1998;18(9):635–7.
Luostarinen L, Heinonen T, Luostarinen M, Salmivaara A. Diagnostic lumbar puncture. Comparative study between 22-guage pencil point and sharp bevel needle. J Headache Pain. 2005;6(5):400–4.
Torbati S, Katz D, Silka P, Younessi S. Comparison of blunt versus sharp spinal needles used in the emergency department in rates of post-lumbar puncture headache. Ann Emerg Med. 2009;54:S73.
Halpern S, Preston R. Postdural puncture headache and spinal needle design. Metaanalyses. Anesthesiology. 1994;81(6):1376–83.
Frank RL. Lumbar Puncture and Post-Dural Puncture Headaches: Implications for the Emergency Physician. J Emerg Med. 2008;35(2):149–57.
Pelzer N, Vandersteene J, Bekooij TJ, Schoonman GG, Wirtz PW, Vanopdenbosch LJ, et al. Are atraumatic spinal needles as efcient as traumatic needles for lumbar puncture? Neurol Sci. 2014;35(12):1997–9.
Tung CE, So YT, Lansberg MG. Cost comparison between the atraumatic and cutting lumbar puncture needles. Neurology. 2012;78(2):109–13.
Shlamovitz GZ, Shah NR, Lutsep HL. Lumbar Puncture Technique. Emedicine Medscape Updated: Apr 22, 2016;1–4 [cited 2016 jun 1]. Available from: http://emedicine.medscape.com/article/80773-technique.
Bonadio W. Pediatric Lumbar Puncture and Cerebrospinal Fluid Analysis. J Emerg Med. 2014;46(1):141–50.
Lavi R, Rowe JM, Avivi I. Lumbar puncture: It is time to change the needle. Eur Neurol. 2010;64(2):108–13 .
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.