Objective:

The objective of this study was to compare the effectiveness of Ultrasound Guided Diagnostic Lumbar Puncture to Traditional Landmark based method and compare the success and complications rate. 

Background:

Lumbar puncture is a common neurologic procedure done in inpatient and outpatient settings to obtain cerebrospinal fluid. Success or failure depends on various factors, including age, body mass index, prior back surgery, spine anatomy, expertise of the performer and technical aspects. Studies done in emergency departments, pediatrics and anesthesia settings have shown mixed results with overalls superiority of ultrasound guided technique. There is a paucity of studies done in neurology to look at the benefits of ultrasound guided LP over traditional LP in outpatient or inpatient settings. In “Ultra GUD LP - Ultrasound Guided Diagnostic Lumbar Puncture in Neurology” study, we compared the effectiveness of both techniques in an outpatient neurology setting.

Design/Methods:

The study was a prospective randomized control study done in clinic settings from 2017 to 2022 with approval by local IRB and registered on Clinical Trials.gov We enrolled subjects needing lumbar puncture from the outpatient neurology clinics at the author's institution. After written informed consent, subjects were randomized into a traditional-landmark based or ultrasound guided LP approach. The primary author performed all LPs using a standard spinal needle in a similar fashion.

Results:

Traditional landmark based LP proved to be as effective as Ultrasound-guided LP in obtaining CSF with a similar success and complication rate with significantly less time taken in the study population.

Conclusions:

Ultrasound guidance doesn’t significantly affect outcomes of lumbar puncture in the regular adult population. Performer expertise and study settings are also important factors in a successful lumbar puncture. Ultrasound use in specific populations with high BMI, prior back surgeries, deformities of the spine need to be studied further