Conventional imaging parameters are not sufficient to penetrate extra layers of patient fat the density properties of human tissue become problematic in patients weighing ≥113 kg. 5 LP is more difficult when the needle length increases, and if fluoroscopy is used, landmarks are more difficult to visualize with increasing subcutaneous fat. Increasing BMI has been shown to result in a longer fluoroscopy time for LP access. Equipment has weight limits above which table function is not assured, and the fluoroscopy table may not tilt. The obese patient who needs CSF sampling presents multiple potential difficulties. Patients are not able to fit on imaging equipment, including procedural equipment, designed for the “average-sized” patient. The impact of obesity on the radiology practice is now being recognized. The financial impact of obesity on the health care system is well-known, because this chronic condition contributes to the development of diabetes, cardiovascular issues, and, now increasingly recognized, idiopathic intracranial hypertension (IIH), previously termed “pseudotumor cerebri.” 3, 4 In our practice, patients often weigh >136 kg, with a BMI of >50. 2 BMI is calculated as weight in kilograms divided by the square of the height in meters, and obesity is defined as a BMI of >30. 1Ĭurrent estimates from the Centers for Disease Control and Prevention are that more than one-third (34.9% or 78.6 million) of adults in the United States are obese. As more patients have undergone spine surgery and with the current increase in body mass index (BMI) of the general population, the radiologist has been consulted with increasing frequency to perform the LP fluoroscopic guidance. Lumbar puncture (LP) has, for many years, been the responsibility of the internal medicine physician or the neurologist. Combining our experience from performing these procedures on an obese population, we would like to share our tips, especially with trainees early in their career.ĪBBREVIATIONS: BMI body mass index IIH idiopathic intracranial hypertension LP lumbar puncture Our goal with this review was to describe our techniques for lumbar puncture in the difficult patient, with emphasis on using fluoroscopy in the obese patient and to suggest maneuvers that might make the procedure easier. The procedure is more difficult when the needle length increases, and if fluoroscopy is used, landmarks are more difficult to visualize with increasing subcutaneous fat. Radiology, in fact, is now the dominant overall provider of lumbar puncture procedures. As more patients have undergone spine surgery and with the current increase in body mass index of the general population, the radiologist has been consulted with increasing frequency to perform lumbar puncture with fluoroscopic guidance. Visit the Pathology Tests Explained website for more information about lumbar punctures.SUMMARY: Lumbar puncture has, for many years, been the responsibility of the internal medicine physician or the neurologist. Resources and support About lumbar puncture If you have worsening headache, fever or weakness in the legs, you should see a doctor urgently. An infection is possible, but is very rare. There can be bleeding, especially if you are taking blood thinning medicine. Some people experience headache, backache or pain in the legs. You shouldn’t need to stay in hospital overnight, but someone should drive you home. You might be asked to lie down for an hour or more after the procedure, to prevent a headache. Once the procedure is finished, the needle will be taken out and a dressing will be put on the injection site. A small amount of fluid will be withdrawn. Once the area is numb, another needle will be put into your back, through the skin and between the bones of your spine to reach the fluid around your spinal cord. Your back will be cleaned thoroughly and a small amount of local anaesthetic injected into the lower back. You will be asked to keep very still, either lying on your side with your knees close to your chin, or seated. You should ask your doctor if there is anything you need to do to prepare. Usually, no preparation is needed for a lumbar puncture, but everybody’s situation is different. Lumbar puncture is also sometimes used to treat certain problems, either by injecting something into this fluid, or by removing some of the fluid. It can then be sent for laboratory testing. Why is a lumbar puncture performed?Ī lumbar puncture is performed to sample the fluid that sits around the brain and spinal cord, called cerebrospinal fluid or CSF. Lumbar puncture is sometimes called a ‘spinal tap’. This can help to diagnose and sometimes treat problems of the brain and spinal cord. Related information on Australian websitesĪ lumbar puncture involves putting a needle into the lower back to reach the fluid that sits around the spinal cord.
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