Risk of intervertebral disc joint puncture during lumbar puncture

• Published in: Clinical neurology and neurosurgery Vol. 200; p. 106107
• Main Authors: Ertas, Ahmet, Gediz, Tolga, Ozdol, Cagatay, Gurses, Ilke Ali, Onder, Merve, Uzel, Mehmet, Aghayev, Kamran
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2021; Elsevier Limited
• Subjects: Back pain; Body wall; Cadavers; Clinical medicine; Complication; Degeneration; Degenerative disc disease; Headaches; Intervertebral disc; Intervertebral discs; Lumbar puncture; Statistical analysis; Vertebrae; Complication; Intervertebral disc; Lumbar puncture; Degenerative disc disease
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2020.106107

•There is a considerable risk of inadvertent disc penetration during lumbar puncture if needle is advanced too far.•This complication is usually unnoticed during the procedure but may trigger disc degeneration leaving the source of condition unknown.•The true incidence of disc penetration in clinical setting is unknown and therefore strict adherence to correct technique is required to avoid this complication. Penetration of intervertebral disc joint during lumbar puncture might be unnoticed during procedure. However, accelerated degeneration of the disc joint is a long-term consequence of inadvertent penetration. In this paper, we aimed to demonstrate and evaluate the risk of disc puncture during standard lumbar puncture. 50 human cadavers were used in this study. Disc puncture risk was assessed by using worst case scenario model. Lumbar puncture was performed in a standard fashion using midline route at L3−4, L4−5 and L5-S1 levels. The needle was advanced until it hit resistance from the bone. Lateral X-ray was used to visualize the needle position. Needle ended up in two possible locations - posterior vertebral body wall and intervertebral disc space. The probability of puncturing the joint was 20 % for L3−4, 38 % for L4−5, 16 % for L5-S1. Total probability of disc penetration was 25 %. Statistical analysis revealed significantly increased risk for performing LP at L4−5 level in comparison with L5-S1 (p = 0.023). Lumbar puncture carries significant risk of intervertebral disc penetration. This complication is not realized during the procedure and lead to accelerated joint degeneration.