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Spinal taps carry higher risks for infants and elderly, study shows
Date:3/18/2009

more precisely locates where to put the needle, avoiding bone spurs and bony narrowings related to scoliosis. Sometimes the placement of the needle during the procedure causes some bleeding into the cerebrospinal fluid. This type of problem, seen in up to a quarter of cases, makes it more difficult to diagnose the patient, Johnson said, because it is hard to determine if the blood is a symptom of the condition or a result of the lumbar puncture.

"Because cerebrospinal fluid tests provide very valuable information in making the diagnoses of several serious diseases such as bleeding in the head, cancer of the brain or spine, meningitis, infection of the brain, or multiple sclerosis and because obtaining the fluid involves insertion of a long needle into the spine, it is important that we optimize the most safe and effective methods of doing this procedure," Johnson said.

For the study, researchers reviewed the files of more than 750 patients ranging in age from less than 1 year to 90 years old. All had received a fluoroscopy-guided lumbar puncture in emergency room, outpatient or inpatient settings.

Results show that fluoroscopy-guided lumbar punctures failed in about 60 percent of the cases that involved very young patients, meaning that no cerebrospinal fluid could be obtained at all. The needle caused bleeding into the cerebrospinal fluid in about 25 percent of the infant cases where the doctors were able to obtain the fluid, according to the study.

"This finding suggests that in infants, physicians may opt to use ultrasound to guide the needle for lumbar puncture or work without the cerebrospinal fluid altogether," Johnson said. "It's just not worth the radiation and high chance of failure or bleeding that fluoroscopy-guided lumbar puncture carries in these very young patients."

For patients older than 80, the researchers found that such bleeding happened in about 26 percent of cases twice the rate seen in patie
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Contact: Jessica Guenzel
jguenzel@wfubmc.edu
336-716-3487
Wake Forest University Baptist Medical Center
Source:Eurekalert

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