Complications of lumbar puncture

The landmarks of obese patients are difficult to determine, which is a challenge for physicians. Osteoarthritis, ankylosing spondylitis, kyphosis, history of lumbar surgery, and degenerative disc disease may make lumbar puncture more difficult to complete. For patients with such diseases, it may be necessary to consult an anesthesiologist or interventional radiologist to improve the success rate of lumbar puncture.　Complications of lumbar puncture include brain herniation, impaired cardiopulmonary function, local or involved pain, headache, bleeding, infection, arachnoid epidermal cyst and CSF leakage. The most common complication is headache, which occurs as high as 36.5% within 48 hours after lumbar puncture. The cause of the headache is that the rate of CSF leakage from the puncture site exceeds the rate of CSF production. The increase in the incidence of headache is related to the thickness of the waist puncture needle used. The most serious complication is brain herniation. If the pressure difference between the cranial cavity and the spinal cord cavity is large, it may cause brain herniation. During a lumbar puncture, this pressure difference can increase, leading to brainstem herniation. Doctors can find high-risk patients who are prone to brain herniation through detailed medical history and neurological examination. If the physician still has concerns about performing a lumbar puncture, CT may be helpful, but the increase in intracranial pressure may not always be detected by imaging. However, not all patients need CT examination because it can delay diagnosis and treatment. Patients with hemorrhagic diathesis are very prone to bleeding, which can cause compression of the spinal cord. Regarding the relationship between the degree of coagulopathy and the risk of bleeding, there is no absolute standard, so physicians must make judgments based on clinical conditions. Arachnoid epidermal cysts are caused by skin emboli entering the subarachnoid space, which can be avoided by using a puncture needle with a needle core.

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