Spinal Injury Following Lumbar Puncture, pp. 693-702
Authors: Seema Kalra, Mathew Keating and Alexandra J. Sinclair
Abstract: Lumbar puncture (LP) is a frequently used procedure in the diagnostic, interventional and anaesthetic settings usually associated with low morbidity. Although uncommon, spinal injury can occur as a result of spinal needling and result in a number of complications including haematoma formation, direct trauma and chemical injury. Spinal haematomas (epidural, subdural and subarachnoid) are the most significant complication due to potential cord compression and consequent paraparesis. Early identification of spinal trauma following LP is vital to expedite management and improve outcome as delayed presentation is associated with permanent disability in 50% of cases. Physician awareness of complications following LP is, therefore, vital. Spinal haematomas should be suspected in patients describing severe radicular pain, lumbar pain, sensory disturbance or weakness, despite normal coagulation and a non-traumatic LP. Additionally, vigilance is necessary up to 5 days post procedure as presentation can be delayed in some cases. In all patients, with suspected spinal haematoma, urgent evaluation with magnetic resonance imaging is mandatory to diagnose and assess spinal compression. Once diagnosed, however, an evidence base for management is not established. Many spinal haematomas, particularly those in the subdural space, require prompt surgical decompression. In patients with early signs of neurological recovery, conservative management and close observation may be employed. In this chapter avoidance, recognition and management of spinal injuries following LP are discussed.