From the Guidelines
Lumbar puncture (LP) carries several risks, including post-lumbar puncture headache, bleeding, infection, pain, and nerve damage, with the most common risk being a post-lumbar puncture headache affecting about 10-30% of patients, as reported in the most recent study 1. The risks associated with LP can be minimized by using atraumatic needles, which have been shown to reduce the risk of post-dural-puncture headache by 60% compared to conventional needles 1.
Common Risks
- Post-lumbar puncture headache: occurs in 10-30% of patients, typically within 48 hours after the procedure, and is caused by cerebrospinal fluid leakage from the puncture site 1
- Bleeding at the puncture site: rare, but can be reduced by normalizing hemostatic factors such as platelet counts and coagulation parameters 1
- Infection: rare, but can be minimized with proper sterile technique 1
- Pain or discomfort during the procedure: common, but can be managed with local anesthesia and sedation 1
- Nerve damage or irritation: rare, but can cause temporary numbness or tingling in the legs 1
Rare but Serious Risks
- Brain herniation: very rare, but can occur if there is increased intracranial pressure, which is why doctors typically check for signs of increased pressure before performing the procedure 1
- Cerebral or spinal hemorrhage: very rare, but can be reduced by normalizing hemostatic factors such as platelet counts and coagulation parameters 1
- Spinal epidural or subdural cerebral hematoma: very rare, but can be reduced by using atraumatic needles and minimizing the risk of bleeding 1
Minimizing Risks
- Using atraumatic needles: reduces the risk of post-dural-puncture headache by 60% compared to conventional needles 1
- Normalizing hemostatic factors: reduces the risk of bleeding and hemorrhage 1
- Proper sterile technique: minimizes the risk of infection 1
- Local anesthesia and sedation: manages pain and discomfort during the procedure 1
- Monitoring for signs of increased intracranial pressure: minimizes the risk of brain herniation 1
From the Research
Risks of Lumbar Puncture
The risks associated with lumbar puncture (LP) include:
- Post-dural puncture headache (PDPH) 2, 3, 4, 5
- Hemorrhage 2
- Herniation 2, 3, 6
- 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 reduced by using proper technique and indications 6. The use of atraumatic needles, such as the Sprotte needle, can also reduce the incidence of PDPH 3, 5. The incidence of complications was found to be 10.3% in a study of 525 adult lumbar punctures, with the majority being minor and consisting of PDPH 4.
Prevention and Treatment
Preventative measures, such as pointing the face of the bevel in the direction of the patient's side and replacing the stylet and rotating the needle 90 degrees before withdrawing the needle, can reduce the incidence of PDPH 3. Treatment strategies for complications, such as PDPH, can include bed rest, although evidence suggests that no bed rest is necessary when using atraumatic needles 5. Familiarity with potential LP complications and their management can equip clinicians to effectively manage these complications through prompt recognition, timely diagnosis, and implementation of appropriate preventative measures 2.