Is T11 Compression Fracture a Contraindication for Lumbar Puncture?
No, a T11 compression fracture is not a contraindication to performing a lumbar puncture, as the fracture is located in the thoracic spine well above the typical lumbar puncture sites (L3-L4, L4-L5, or L5-S1).
Anatomical Considerations
The key issue is anatomical separation between the fracture site and the lumbar puncture location:
- T11 is a thoracic vertebra, positioned several vertebral levels above where lumbar puncture is performed 1, 2
- Standard lumbar puncture sites are L3-L4, L4-L5, or L5-S1, which are anatomically distant from T11 3, 4
- The needle trajectory during lumbar puncture does not traverse or approach the T11 level 5, 6
Actual Contraindications to Lumbar Puncture
The established contraindications to lumbar puncture do not include remote spinal fractures 1, 2:
Absolute contraindications include:
- Moderate to severe impairment of consciousness or fall in GCS >2 1
- Focal neurological signs including unequal, dilated, or poorly responsive pupils 1
- Papilledema indicating raised intracranial pressure 1
- Systemic shock or clinical instability 1
- Local infection at the lumbar puncture site 1
- Coagulation abnormalities (platelet count <100 × 10⁹/L) 1
- Active anticoagulant therapy 1
- Elevated intracranial pressure with evidence of mass lesion 5
Important Clinical Caveat
One specific scenario requires caution: If the patient is a female with a thoracic compression fracture (which includes T11), there is a small risk of a lower-than-normal conus medullaris terminus 3:
- Female patients with thoracic vertebral compression fractures may have the conus medullaris extending as low as L2 3
- This would make the L2-L3 interspace potentially unsafe for lumbar puncture in this population 3
- Solution: Perform lumbar puncture at L3-L4 or lower levels (L4-L5 or L5-S1) to avoid any theoretical risk of cord injury 3, 4
Practical Recommendation
Proceed with lumbar puncture at L3-L4, L4-L5, or L5-S1 levels if clinically indicated, ensuring no other contraindications are present 1, 2. If the patient is female with a T11 compression fracture, avoid the L2-L3 interspace and use L3-L4 or lower 3.