From the Guidelines
Lumbar puncture carries several risks, including post-dural-puncture headache, which affects up to 35% of patients, and can be debilitating, but the use of atraumatic needles can significantly reduce this risk. The most common risks associated with lumbar puncture include:
- Post-dural-puncture headache, which can occur in up to 35% of patients 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 In very rare cases, more serious complications can occur, such as brain herniation, seizures, or spinal hematoma. The risk of complications increases in patients with bleeding disorders, those on blood thinners, or individuals with anatomical abnormalities of the spine. To minimize these risks, patients should remain lying flat for several hours after the procedure, increase fluid intake to help replace cerebrospinal fluid, and report any severe headaches, fever, stiff neck, or neurological symptoms immediately. The use of atraumatic needles has been shown to reduce the risk of post-dural-puncture headache, with a relative risk of 0.40 (95% confidence interval 0.34 to 0.47) compared to conventional needles 1. Additionally, a study published in 2022 found that the incidence of typical post-LP headache ranges from 0.9% to 9.0%, and that more than 85% of post-LP headaches resolve without treatment 1. The use of atraumatic needles is strongly recommended for all patients undergoing lumbar puncture, as they decrease complications and are no less likely to work than conventional needles.
From the Research
Risks of Lumbar Puncture
The risks associated with lumbar puncture (LP) include:
- Post-dural puncture headache (PDPH) 2, 3, 4
- Hemorrhage 2, 5
- Herniation 2, 3
- Infection 2, 3
- Cranial neuropathies 3
- Nerve root irritation 3
- Low back pain 3
- Stylet associated problems 3
- Bleeding complications 3
- Subdural hematoma 5
- Spontaneous frontal epidural hematoma 5
Incidence and Severity of Complications
The incidence of complications can be reduced by proper technique and the use of certain needles, such as the Sprotte atraumatic needle 3. The majority of complications are minor in severity, with PDPH being the most common complication 4.
Patient Outcomes
These complications can lead to suboptimal patient outcomes, including significant morbidity and mortality in some instances 2. It is essential for clinicians to be familiar with these complications to effectively manage them through prompt recognition, timely diagnosis, and implementation of appropriate preventative measures 2.