Abstract
Objectives
Failed lumbar puncture (LP) is a common indication for referral for radiologically guided LP. This study aims to evaluate what percentage of the hospital population would fail an LP using a standard 9-cm needle because of obesity and a skin to subarachnoid space distance greater than 9 cm.
Methods
Images of 402 consecutive patients undergoing computed tomography of the abdomen and pelvis were reviewed. Skin to subarachnoid space distance was calculated using sagittal images. A survey was conducted among junior hospital doctors to assess their experience of performing lumbar puncture in obese patients.
Results
Four hundred patients were included. Fifty-five patients (13.8 %) had a skin to subarachnoid space distance greater than 9 cm. Intra-abdominal fat, subcutaneous fat and abdominal girth correlated with distance between the skin and subarachnoid space. Among junior doctors, 68.3 % (n = 41) reported LP failure on an obese patient; 78.4 % (n = 47) were unaware of the existence of a longer needle and 13.3 % (n = 8) had experience using a longer needle.
Conclusions
A significant proportion of the hospital population will fail LP with a standard length spinal needle. Selecting a longer needle may be sufficient to successfully complete LP in obese patients.
Key Points
• Lumbar puncture failure commonly leads to referral for an image-guided procedure
• Standard lumbar puncture may fail in 13.8 % of patients due to obesity
• 78.4 % of trainee doctors are unaware of the existence of longer spinal-needles
• Using longer spinal needles may allow successful LP in obese patients
Similar content being viewed by others
Abbreviations
- LP:
-
Lumbar puncture
- HR:
-
Hazard ratio
- NCHD:
-
Non-consultant hospital doctors
References
http://www.cdc.gov/obesity/data/trends.html. Accessed 05/02/2012
http://www.iuna.net/wp-content/uploads/2010/12/National-Adult-Nutrition-Survey-Summary-Report-March-2011.pdf, accessed 05/02/2012
Campbell N, Buckley O, McGlone B, O’Shea D, Torreggiani WC (2009) Obesity in Ireland in 2008: what radiological equipment is available to image the obese patient? Ir Med J 102:116–117
Buckley O, Ward E, Ryan A, Colin W, Snow A, Torreggiani WC (2009) European obesity and the radiology department. What can we do to help? Eur Radiol 19:298–309
Palmer SK, Abram SE, Maitra AM, von Colditz JH (1983) Distance from the skin to the lumbar epidural space in an obstetric population. Anesth Analg 62:944–946
Clinkscales CP, Greenfield MLVH, Vanarase M, Polley LS (2007) An observational study of the relationship between lumbar epidural space depth and body mass index in Michigan parturients. Int J Obstet Anesth 16:323–327
Gerig HJ, Kern F (1985) Success and failure rate in peridural anesthesia. A 1-year study. Reg Anesth 8:25–32
Le Coq G, Ducot B, Benhamou D (1998) Risk factors for inadequate pain relief during epidural analgesia for labor and delivery. Can J Anaesth 45:719–723
Dixon AK (1983) Abdominal fat assessed by computed tomography: sex difference in distribution. Clin Radiol 34:189–191
Ravi KK, Kaul TK, Kathuria S, Gupta S, Khurana S (2011) Distance from skin to epidural space: correlation with body mass index (BMI). J Anaesthesiol Clin Pharmacol 27:39–42
Bahk JH, Kim JH, Lee JS, Lee SC (1998) Computed tomographic study of lumbar (L3-4) epidural depth and its relationship to physical measurements in young adult men. Reg Anesth Pain Med 23:262–265
Carnie J, Boden J, Gao Smith F (2002) Prediction by computerised tomography of distance from skin to epidural space during thoracic epidural insertion. Anaesthesia 57:701–704
Kao MC, Tsai SK, Chang WK, Liu HT, Hsieh YC, Hu JS, Mok MS (2004) Prediction of the distance from skin to epidural space for low-thoracic epidural catheter insertion by computed tomography. Br J Anaesth 92:271–273
Balki M, Lee Y, Halpern S, Carvalho JC (2009) Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg 108:1876–1881
Craig F, Stroobant J, Winrow A, Davies H (1997) Depth of insertion of a lumbar puncture needle. Arch Dis Child 77:450
Segal S, Beach M, Eappen S (1996) A multivariate model to predict the distance from the skin to the epidural space in an obstetric population. Reg Anesth 21:451–455
Stamatakis E, Moka E, Siafaka I, Argyra E, Vadalouca A (2005) Prediction of the distance from the skin to the lumbar epidural space in the Greek population, using mathematical models. Pain Pract 5:125–134
Kalichman L, Guermazi A, Li L, Hunter DJ (2009) Association between age, sex, BMI and CT-evaluated spinal degeneration features. J Back Musculoskelet Rehabil 22:189–195
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Halpenny, D., O’Sullivan, K., Burke, J.P. et al. Does obesity preclude lumbar puncture with a standard spinal needle? The use of computed tomography to measure the skin to lumbar subarachnoid space distance in the general hospital population. Eur Radiol 23, 3191–3196 (2013). https://doi.org/10.1007/s00330-013-2909-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-013-2909-8