Complications
It is widely accepted that lumbar puncture is a safe intervention, yet
complications can happen.25 The most common
complication is Post lumbar Puncture headache (PLPH). It is an
orthostatic headache due to CSF leakage, which usually starts within 48
hours in 90% of the patients.36 In 80%, it resolves
within seven days or less, but in the minority, may persist for weeks or
months. The reported incidence varies from 1% to
50%.37 The patient-related risk factors for high risk
of PLPH include younger age, past history of headache, female
< 40 years old, anxiety about post-LP
complications.25 The procedure-related factors for
lower risk of PLPH include 25G atraumatic needle, less than four LP
attempts, passive withdrawal of CSF, lateral recumbent position and
collection up to 30 mL.25 Among these, needle tip
design constitutes the most important factor, whether
traumatic(standard) or atraumatic needle tip. Nath et al. did a
meta-analysis of randomized controlled trials of 102 reported studies,
comprising 31,412 subjects on the occurrence of post-lumbar puncture
headache.36 The incidence of PLPH in the atraumatic
needle subjects constituted 4.2 % compared to the standard needle group
at 11%.The study found an incidence PLPH of 4.2% in the atraumatic
needle group and 11.0% in the conventional needle group
(p<0.0001,relative risk 0.40, 95% CI 0.34–0.47).With the
atraumatic needles, there was also decreased need for EDBP, analgesia
and post LP hospitalization with similar success rate and incidence of
traumatic tap compared to standard needles.36
In a retrospective study by Moisset et al., atraumatic needles were
utilized in only 8% out of a total of 6594 lumbar punctures done in
2014, in two French University hospitals, showing considerable
unawareness among practitioners.38 As PLPH is an
orthostatic headache, initially it is treated with mild analgesics and
bed rest.36If persistent, caffeine, theophylline and
hydrocortisone can be tried but evidence is lacking
to.39 Evidence does not support bed rest or fluid
supplementation for preventing Post-lumbar puncture
headache.40 An epidural blood patch is considered if
PLPH persists for more than five days.41 Back pain and
nerve root irritation occur in 15% and 11% of cases, less with
atraumatic needles.36 Other rare complications include
cerebral herniation (3-7%),42 bacterial meningitis
(<0.1%),43 spinal hematoma (incidence
unknown)44 and cerebral venous sinus thrombosis
(incidence unknown ).45