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Spinal Injury Following Lumbar Puncture, pp. 693-702 $100.00
Authors:  Seema Kalra, Mathew Keating and Alexandra J. Sinclair
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. 

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Spinal Injury Following Lumbar Puncture, pp. 693-702