Development of the cutting spinal needle tip (5)

In 1922, Hoyt published his theory that the commonly used large-caliber needles, due to their rigidity, led to an increase in the loss of large holes in the dura mater and cerebrospinal fluid. He suggested using the double-needle technique, using a larger-caliber outer needle to penetrate the external tissue, and a thinner inner needle to penetrate the dura mater and arachnoid membrane. This is a return to the principle of the thinner Corning needle with introducer, which has been replaced by the larger Bier needle. The outer needle used by Hoyt is a modified Bier needle with a long cutting bevel (Figure 7). Compared with other needles used at the time, the incidence of PDPH with Hoyt needles was much lower.

Figure 7

Hoyt needle (1922).

As with many medical advances, the next development was a technological one. In the 1920s, Firth Brearly heat-tempered stainless steel was developed in England. This was rust-resistant but not rustproof. Towards the end of World War I, Germany was manufacturing V2A steel (a hard steel alloy), and at the conclusion of the war it was exported to America. This steel was rustproof, very resistant to breaking and could be worked to a sharp point that was resistant to deformation. The low carbon steels were replaced by higher carbon, rustproof products that became the mainstay of needle production.

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