From the Guidelines
Lumbar puncture (LP) carries several risks, including post-procedure headache, bleeding, infection, pain, and nerve irritation, with the most common risk being a post-procedure headache affecting about 10-30% of patients, as reported in the most recent study 1. The risks associated with LP can be categorized into common and rare complications. Common complications include:
- Post-procedure headache, which typically begins within 48 hours and is caused by cerebrospinal fluid leakage from the puncture site, leading to decreased pressure in the brain 1
- Bleeding at the puncture site
- Infection, although rare with proper sterile technique
- Pain or discomfort during the procedure
- Nerve irritation that may cause temporary numbness or tingling in the legs Rare but potentially serious complications include:
- Brain herniation (if there's increased intracranial pressure)
- Seizures
- Spinal hematoma The risk of these complications can be minimized through proper patient selection, using appropriate technique, and having the procedure performed by experienced practitioners 1. Factors that can reduce the risk of post-procedure headache include:
- Using atraumatic needles, which have been shown to consistently reduce the risk of major adverse effects associated with LP 1
- Age >65 years, which has been associated with a reduced risk of typical post-LP headache and back pain 1
- Dementia, which has been associated with a reduced risk of typical post-LP headache and back pain 1
- Lying flat for a period after the procedure and increasing fluid intake, which can help reduce the chance of post-procedure headache 1.
From the Research
Risks of Lumbar Puncture
The risks associated with lumbar puncture (LP) include:
- Post-dural puncture headache, which can be debilitating 2, 3, 4, 5
- Hemorrhage 2
- Herniation 2, 3
- Infection 2, 3
- Cranial neuropathies 3
- Nerve root irritation 3
- Low back pain 3
- Stylet associated problems 3
- Bleeding complications 3
Incidence of Complications
The incidence of complications can be significant, with one study reporting a complication rate of 10.3% 4. However, the majority of these complications are minor in severity, with post-dural puncture headache being the most common complication 4.
Factors Affecting Risk
The risk of complications can be affected by various factors, including:
- Age 5
- Sex 5
- Needle size and shape 5
- Lumbar puncture procedure 5
- Use of atraumatic needles, such as the Sprotte needle, can reduce the risk of post-dural puncture headache 3, 5
Prevention and Management
Preventative measures, such as using atraumatic needles and proper technique, can help reduce the risk of complications 2, 3, 5. Prompt recognition and timely diagnosis of complications are also crucial in managing and treating them effectively 2.