Abstract

Success rates of lumbar punctures (LPs) in children are reportedly as low as 50%. In addition to procedural complications and failure, difficult LPs are a risk factor for traumatic LPs (TLPs), which can potentially affect diagnostic utility and alter treatment plans for pediatric oncology patients. To identify the intrinsic factors associated with technically difficult LPs in the pediatric oncology population, we performed a retrospective review of patients who required diagnostic imaging modalities for LP procedures at a single pediatric oncology institution between September 2008 and November 2018. We evaluated data from 64 LPs performed in 33 patients who were referred for image-guided LPs after undergoing technically difficult LPs that were unsuccessful using anatomic landmarks. In these cases, 96.9% of patients had at least one of the following intrinsic factors: body mass index (BMI) ≥ 25, anatomic spinal abnormalities, history of ≥ 5 previous LPs, age < 12 months, and history of back surgery. Elevated BMI was the most common factor associated with difficult LP (81.8%), followed by spinal abnormalities (51.5%), and history of ≥ 5 previous LPs (33.3%). Age < 12 months and history of back surgery were also associated with difficult LPs, but at a lower frequency. On the basis of these findings, we propose clinical recommendations for preprocedural identification of patients at risk of difficult LPs to reduce complications, including TLP, failure, and exposure to general anesthesia.

摘要

据报道，儿童腰椎穿刺 (LPs) 的成功率低至 50%。除了手术并发症和失败之外，困难的 LP 是创伤性 LP (TLP) 的一个风险因素，这可能会影响诊断效用并改变儿科肿瘤患者的治疗计划。为了确定与儿科肿瘤人群中技术困难的 LP 相关的内在因素，我们对 2008 年 9 月至 2018 年 11 月期间在一家儿科肿瘤机构需要诊断成像模式进行 LP 程序的患者进行了回顾性审查。我们评估了来自 64 名 LP 的数据在 33 名患者中进行了图像引导的 LP，这些患者在经历了技术上困难的 LP，这些 LP 使用解剖标志不成功。在这些情况下，96。9% 的患者至少有以下内在因素之一：体重指数 (BMI) ≥ 25、脊柱解剖异常、既往 LP ≥ 5 次、年龄 < 12 个月和背部手术史。BMI 升高是与困难 LP 相关的最常见因素（81.8%），其次是脊柱异常（51.5%）和 ≥ 5 次既往 LP 病史（33.3%）。年龄 < 12 个月和背部手术史也与困难的 LP 相关，但频率较低。在这些发现的基础上，我们提出临床建议，以在术前识别有困难 LP 风险的患者，以减少并发症，包括 TLP、失败和全身麻醉暴露。BMI 升高是与困难 LP 相关的最常见因素（81.8%），其次是脊柱异常（51.5%）和 ≥ 5 次既往 LP 病史（33.3%）。年龄 < 12 个月和背部手术史也与困难的 LP 相关，但频率较低。在这些发现的基础上，我们提出临床建议，以在术前识别有困难 LP 风险的患者，以减少并发症，包括 TLP、失败和全身麻醉暴露。BMI 升高是与困难 LP 相关的最常见因素（81.8%），其次是脊柱异常（51.5%）和 ≥ 5 次既往 LP 病史（33.3%）。年龄 < 12 个月和背部手术史也与困难的 LP 相关，但频率较低。在这些发现的基础上，我们提出临床建议，以在术前识别有困难 LP 风险的患者，以减少并发症，包括 TLP、失败和全身麻醉暴露。