Retrospective Comparative Analysis of Fluoroscopic-Guided Lumbar Puncture in the Routine Prone Versus Lateral Decubitus Position.

Dmitriy Bakrukov,Amar Swarnkar,Zaid Siddique,Rajiv Mangla

doi:10.7759/cureus.18799

Abstract

Objective: We sought to investigate patient outcomes such as success rate, fluoroscopy time, and radiation dose for fluoroscopic-guided lumbar puncture procedures performed in the prone position versus the lateral decubitus (LD) position.Methods: Retrospective chart analysis was performed at a single institution from 2013 to 2019. Cases were separated by performance in the prone or lateral decubitus positions. Data collected include patient characteristics, fluoroscopy time, radiation dose (DAP), puncture level, indication, opening pressure, and success rate. Exclusion criteria include trainee participation and procedures where positioning was unspecified. Mean fluoroscopy time, DAP, and procedure success rate were calculated and compared between groups.Results: Mean fluoroscopy time (min) was 0.97 and 1.07 in the LD and prone groups respectively (p = 0.21). Mean DAP (mGy) was 43.18 and 42.06 in the LD and prone groups respectively (p = 0.38). Success rate was 98.3% and 89.1% in the LD and prone groups respectively (p = 0.04). Room time (minutes) was 64.46 and 77.77 in the LD and prone groups respectively (p = 0.04).Conclusion: Our study found no statistically significant difference in terms of fluoroscopic time or radiation dose when comparing fluoroscopic-guided lumbar punctures in the prone versus lateral decubitus positions. Further analysis did show a statistically significant increased success rate and a shorter room time for the lateral decubitus position.

Highlights

Lumbar punctures (LPs) have been performed at the bedside using specific anatomical landmarks as guidance for needle insertion
While evidence-based guidelines are lacking for the performance of fluoroscopic-guided lumbar puncture (FGLP), a previously performed study has shown that nearly 90% of all FGLP's are performed in the prone position, with 72% of opening pressures being performed in the prone position as well [5]
The latter finding is important as studies have previously shown that opening pressures may be overestimated in the prone position when compared to the decubitus position [5,6], a finding that has resulted in the majority of neurologists in our institution requesting that all opening pressures be performed in the decubitus position, a trend likely seen across the country

Summary

Introduction

Lumbar punctures (LPs) have been performed at the bedside using specific anatomical landmarks as guidance for needle insertion. While evidence-based guidelines are lacking for the performance of FGLP, a previously performed study has shown that nearly 90% of all FGLP's are performed in the prone position, with 72% of opening pressures being performed in the prone position as well [5]. The latter finding is important as studies have previously shown that opening pressures may be overestimated in the prone position when compared to the decubitus position [5,6], a finding that has resulted in the majority of neurologists in our institution requesting that all opening pressures be performed in the decubitus position, a trend likely seen across the country

Methods

Results

Discussion

Conclusion