Fluoroscopic-Guided Lumbar Puncture: Fluoroscopic Time and Implications of Body Mass Index-A Baseline Study

• Type of Material: Article
• Authors: Srikanth Boddu, Emory University; Amanda Corey, Emory University; Ryan Peterson, Emory University; Amit Saindane, Emory University; PA Hudgins, Emory University Hospital; Z Chen, Emory University; X Wang, Emory University; Kimberly Applegate, Emory University
• Language: English
• Date: 2014-08-01
• Publisher: AMER SOC NEURORADIOLOGY
• Publication Version: Final Published Version
• Copyright Statement: © 2014 by American Journal of Neuroradiology
• Final Published Version (URL): http://dx.doi.org/10.3174/ajnr.A3914
• Title of Journal or Parent Work: AMERICAN JOURNAL OF NEURORADIOLOGY
• Volume: 35
• Issue: 8
• Start Page: 1475
• End Page: 1480
• Keywords: OBESITY; Science & Technology; Life Sciences & Biomedicine; Radiology, Nuclear Medicine & Medical Imaging; Neuroimaging; Neurosciences & Neurology; RADIATION-EXPOSURE; UNITED-STATES; Clinical Neurology
• Research Categories: Health Sciences, Radiology; Biology, Biostatistics

Abstract

BACKGROUND AND PURPOSE: Fluoroscopic-guided lumbar puncture is an effective alternative to bedside lumbar puncture in challenging patients. However, no published guidelines are available for an acceptable range of fluoroscopic time for this procedure. The purpose of this study was to set department benchmark fluoroscopic times for lumbar puncture, accounting for body mass index in our patient population. MATERIALS AND METHODS: We identified and reviewed all patients who underwent fluoroscopic-guided lumbar puncture at 4 hospitals during a 2-year period (July 2011 to June 2013). Data collection included patient information (demographics, body mass index, history of prior lumbar surgery and/or lumbar hardware, scoliosis); procedure details (fluoroscopic time, level of access, approach, needle gauge and length); level of operator experience; and hospital site. A generalized linear model was used to test whether body mass index influenced fluoroscopic time while controlling other factors. RESULTS: Five hundred eighty-four patients (mean age, 47.8 ± 16.2 years; range, 16-92 years; 33% male) had successful fluoroscopic-guided lumbar puncture s. Mean body mass index and fluoroscopic time were higher in female patients (34.4 ± 9.9 kg/m2 and 1.07 minutes; 95% CI, 0.95-1.20) than in male patients (29.2 ± 7.3 kg/m2 and 0.91 minutes; 95% CI, 0.79-1.03). Body mass index (P = .001), hospital site (P < .001), and level of experience (P = .03) were factors significantly affecting fluoroscopic time on multivariate analysis. Benchmark fluoroscopic times in minutes were the following: 0.48 (95% CI, 0.40-0.56) for normal, 0.61 for overweight (95% CI, 0.52- 0.71), 0.63(95% CI, 0.58-0.73) for obese, and 0.86 (95% CI, 0.74 -1.01) in extremely obese body mass index categories. CONCLUSIONS: In patients undergoing fluoroscopic-guided lumbar punctures, fluoroscopy time increased with body mass index We established benchmark fluoroscopic-guided lumbar puncture time ranges as related to body mass index in our patient population.