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. 2017 May 18:8:111-126.
doi: 10.1016/j.dadm.2017.04.007. eCollection 2017.

Consensus guidelines for lumbar puncture in patients with neurological diseases

Sebastiaan Engelborghs  1   2 , Ellis Niemantsverdriet  1 , Hanne Struyfs  1 , Kaj Blennow  3 , Raf Brouns  4 , Manuel Comabella  5 , Irena Dujmovic  6 , Wiesje van der Flier  7 , Lutz Frölich  8 , Daniela Galimberti  9 , Sharmilee Gnanapavan  10 , Bernhard Hemmer  11   12 , Erik Hoff  13 , Jakub Hort  14   15 , Ellen Iacobaeus  16 , Martin Ingelsson  17 , Frank Jan de Jong  18 , Michael Jonsson  19 , Michael Khalil  20 , Jens Kuhle  21 , Alberto Lleó  22   23 , Alexandre de Mendonça  24 , José Luis Molinuevo  25 , Guy Nagels  4   26   27 , Claire Paquet  28 , Lucilla Parnetti  29 , Gerwin Roks  30 , Pedro Rosa-Neto  31   32 , Philip Scheltens  7 , Constance Skårsgard  33 , Erik Stomrud  34 , Hayrettin Tumani  35 , Pieter Jelle Visser  36   37 , Anders Wallin  19 , Bengt Winblad  38 , Henrik Zetterberg  3   39 , Flora Duits  7 , Charlotte E Teunissen  36
Affiliations

Consensus guidelines for lumbar puncture in patients with neurological diseases

Sebastiaan Engelborghs et al. Alzheimers Dement (Amst). .

Abstract

Introduction: Cerebrospinal fluid collection by lumbar puncture (LP) is performed in the diagnostic workup of several neurological brain diseases. Reluctance to perform the procedure is among others due to a lack of standards and guidelines to minimize the risk of complications, such as post-LP headache or back pain.

Methods: We provide consensus guidelines for the LP procedure to minimize the risk of complications. The recommendations are based on (1) data from a large multicenter LP feasibility study (evidence level II-2), (2) systematic literature review on LP needle characteristics and post-LP complications (evidence level II-2), (3) discussion of best practice within the Joint Programme Neurodegenerative Disease Research Biomarkers for Alzheimer's disease and Parkinson's Disease and Biomarkers for Multiple Sclerosis consortia (evidence level III).

Results: Our consensus guidelines address contraindications, as well as patient-related and procedure-related risk factors that can influence the development of post-LP complications.

Discussion: When an LP is performed correctly, the procedure is well tolerated and accepted with a low complication rate.

Keywords: Back pain; Cerebrospinal fluid; Consensus guidelines; Evidence-based guidelines; Headache; Lumbar puncture; Post-LP complications.

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Figures

Fig. 1
Fig. 1
Risk factors for PLPH (A) and nonspecific headache (B) ranked by magnitude (defined by odds ratio) as reported by the multicenter LP feasibility study . Abbreviations: CI, confidence interval; LP, lumbar puncture; OR, odds ratio; PLPH, post-LP headache.
Fig. 2
Fig. 2
Risk factors for back pain ranked by magnitude (defined by odds ratio) as reported by the multicenter LP feasibility study . Abbreviations: CI, confidence interval; LP, lumbar puncture; OR, odds ratio.
Fig. 3
Fig. 3
Lumbar puncture procedure and position of the needle during a lumbar puncture. The procedure involves introducing a needle or its respective introducer at the superior aspect of the inferior spinal process into the subarachnoid space of the lumbar sac, at the L4/L5 level or other level safely (L3/L4) below the spinal cord. The technique is for both atraumatic and cutting bevel needles the same, but when using an atraumatic needle, an introducer is inserted into the interspinal ligament first, after which the smaller atraumatic needle is inserted through the introducer. The introducer should be inserted no more than 2/3 – 1/4 of the total length, depending on the adipose tissue availability. During the procedure, the needle stylet is removed every 2-mm interval to check for flow of CSF. In case a nonrecommended cutting bevel needle is used, it is preferred to hold the bevel in the sagittal plane as this diminishes injury to the dura mater by separating its longitudinal fibers rather than cutting through them and reduces the risk of leakage of CSF after the LP. Abbreviations: CSF, cerebrospinal fluid; LP, lumbar puncture.
Fig. 4
Fig. 4
Schematic representative of lateral (A) and superior (B) aspects of the tips of spinal needles: 1, standard large-bore beveled needle; 2, standard small-bore beveled needle; and 3, atraumatic small-bore needle.
See this image and copyright information in PMC

References

    1. Niemantsverdriet E., Struyfs H., Duits F., Teunissen C., Engelborghs S. Techniques, contraindications and complications of CSF collection procedures. In: Deisenhammer F., Sellebjerg F., Teunissen C.E., Tumani H., editors. Cerebrospinal Fluid in Clinical Neurology. Springer; New York: 2015. pp. 37–57.
    1. McKhann G.M., Knopman D.S., Chertkow H., Hyman B.T., Jack C.R., Jr., Kawas C.H. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:263–269. - PMC - PubMed
    1. Albert M.S., DeKosky S.T., Dickson D., Dubois B., Feldman H.H., Fox N.C. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:270–279. - PMC - PubMed
    1. Dubois B., Feldman H.H., Jacova C., Hampel H., Molinuevo J.L., Blennow K. Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria. Lancet Neurol. 2014;13:614–629. - PubMed
    1. Duits F.H., Martinez-Lage P., Paquet C., Engelborghs S., Lleo A., Hausner L. Performance and complications of lumbar puncture in memory clinics: Results of the multicenter lumbar puncture feasibility study. Alzheimers Dement. 2016;12:154–163. - PubMed