Clin Neurol Neurosurg. 2020 Jul 24:106107. doi: 10.1016/j.clineuro.2020.106107. Online ahead of print.
OBJECTIVE: 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.
PATIENTS AND METHODS: 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.
RESULTS: 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).
CONCLUSION: Lumbar puncture carries significant risk of intervertebral disc penetration. This complication is not realized during the procedure and lead to accelerated joint degeneration.