How to perform a lumbar puncture

How to prevent side effects

Post-lumbar puncture headache (PLPH) is best explained by spinal fluid leakage due to delayed closure of a dural defect but there is no link between the quantity of collected CSF and the risk of PLPH.

The use of an atraumatic Sprotte needle reduces the incidence of post-lumbar puncture headaches.

Different needle designs are available. Cutting bevel needles (standard Quincke and Yale) are the standard needles with a medium cutting bevel and an orifice at the needle tip. Atraucan, Pecan, Sprotte, and Whitacre needles are noncutting, pencil-point, and atraumatic needles.

Among patients who had a lumbar puncture, atraumatic needles are associated with a decrease in the incidence of post-dural puncture headache and in the need for patients to return to the hospital for additional therapy, and had similar efficacy to conventional needles.
 

Conventional needles

Medium (23G-24G) cutting bevel needles are most frequently used in clinical practice. Different hubs with size marking and cannulas of varying diameters and lengths can be used for different patients’ needs (e.g., for overweight patients).

Needle characteristics based on needle length, size, and design

(systematic literature review 2016; consensus guidelines 2017)

History of atraumatic needles

In 1890 H.I. Quincke invented the Quincke cannula - lumbar puncture has become an established part of neurological diagnosis since then. In 1979 the first atraumatic cannula, developed by Prof. Sprotte, was launched.

Atraumatic needles allow better fluid flow while at the same time reducing the incidence of post-lumbar puncture headaches, therefore, they decrease post-puncture morbidity and improve the efficiency of diagnosis.

The closed, ogive-shaped cannula tip displaces tissue during puncture rather than cutting it (compared to the cutting tip of the traumatic cannula). The lateral eye has rounded edges, and is sealed precisely by the stylet during puncture. After the retraction of the cannula, the multi-layered texture of the dura of collagen and elastic fibers closes again.

The surfaces of the atraumatic cannula are polished and free from burrs. This enables the atraumatic cannula to be positioned very accurately, while the smooth inner surface of the cannula optimizes fluid reflux.

Since 2005 the American Academy of Neurology (AAN) recommends the use of atraumatic needles (level A recommendation) for spinal anesthesia as well as for diagnostic lumbar puncture since there is firm scientific evidence of the benefits of atraumatic puncture of the fluid space.

A study from 2012 involving direct comparison between traumatic and atraumatic cannula, confirms the superiority of the atraumatic cannula. Post-lumbar puncture headache was much less common in patients treated with an atraumatic cannula.