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Zhuang YD, Xie HS, Chen J, Wu GH, Wu JF, Chen CM. Computer-modified paramedian approach technique reduces failures and alleviates pain in lumbar puncture: a prospective comparative study. Front Med (Lausanne) 2024; 10:1293689. [PMID: 38317755 PMCID: PMC10838980 DOI: 10.3389/fmed.2023.1293689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/31/2023] [Indexed: 02/07/2024] Open
Abstract
Background The conventional midline approach for lumbar puncture (MAT-LP) has a relatively low success rate of 70%. The paramedian approach can increase the effective puncture area and success rate but lacks standardized guidelines. This study evaluated a computer-modified paramedian approach technique (CMPAT) to optimize lumbar puncture using computational techniques. Methods In this prospective study, 120 patients underwent CMPAT-LP (n = 60) or MAT-LP (n = 60). Puncture failure was defined after 6 attempts. Failure rate, number of attempts, pain score, and complications were compared. Subgroup analysis was conducted for age (≥ 50 years). Results No significant demographic differences existed between groups. Failure rates were 3.3% for CMPAT vs. 13.3% for MAT. Puncture attempts averaged 2.0 vs. 3.5 and pain scores were 2.7 vs. 4.1 for CMPAT and MAT, respectively. All outcomes were significantly improved with CMPAT, especially in elderly patients. No significant difference in complications was observed. Conclusion Compared to MAT, CMPAT-LP demonstrated lower failure rates, fewer puncture attempts, and less pain, without compromising safety. CMPAT may be superior and should be more widely implemented in clinical practice.
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Affiliation(s)
- Yuan-Dong Zhuang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
| | - Hai-Shu Xie
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
| | - Jing Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
| | - Guo-Hua Wu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
| | - Jian-Feng Wu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
- Department of Neurosurgery, Pingtan Comprehensive Experimentation Area Hospital, Pingtan, Fujian, China
| | - Chun-Mei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
- Department of Neurosurgery, Pingtan Comprehensive Experimentation Area Hospital, Pingtan, Fujian, China
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Gerasymchuk M, Durieux JC, Nayate AP. Why, How Often, and What Happens When We Fail: A Retrospective Analysis of Failed Fluoroscopically Guided Lumbar Punctures. AJNR Am J Neuroradiol 2023; 44:722-729. [PMID: 37169540 PMCID: PMC10249695 DOI: 10.3174/ajnr.a7867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/11/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE Important information regarding fluoroscopically guided lumbar puncture (FGLP) performance and referrals is lacking. The purpose of our study was to elucidate the success rate for initial FGLP attempts and re-attempts, reasons for unsuccessful FGLPs, and the relationship between clinical indications and whether patients will undergo a fluoroscopically guided re-attempt, among others. MATERIALS AND METHODS This retrospective study analyzed failed FGLP attempts in hospitalized adult patients at an academic hospital between June 2016 and March 2022. Unsuccessful FGLPs were labeled as insufficient CSF egress. FGLP reports and patients' clinical charts were analyzed for pertinent information such as clinical indication, reason for failure, whether patients received IV fluid before fluoroscopically guided spinal puncture attempt, and which patients returned for another FGLP attempt. Patients' ages and sex were analyzed using descriptive statistics. The OR was used to investigate the relationship between the clinical indications to perform FGLP and whether patients returned for a re-attempt. RESULTS Sixty-three of 1389 (4.5%) patients (median age, 62 years) had failed the initial FGLPs administered by 39 trainees. Twenty-eight of 63 (44.4%) patients (median age, 64 years) underwent a re-attempt within a median of 2 days after the first attempt, and 27/28 (96.4%) re-attempts were successful. A dry tap, no egress of CSF was the top reason (58.7%) for failed FGLP, and 12/13 of patients had a successful FGLP after IV hydration. Twenty-seven of 63 (43%) patients did not undergo a repeat attempt, and 100% were subsequently discharged from the hospital. There was no difference (P > .05) in the likelihood of patients returning for a repeat FGLP based on the clinical indications. CONCLUSIONS Initial and repeat FGLPs have very high success rates. No difference exists in the likelihood of patients returning for a re-attempt based on clinical indication.
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Affiliation(s)
- M Gerasymchuk
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - J C Durieux
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - A P Nayate
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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3
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Depth of spinal needle insertion and its associated factors among patients who underwent surgery under spinal anesthesia. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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4
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Hampel H, Shaw LM, Aisen P, Chen C, Lleó A, Iwatsubo T, Iwata A, Yamada M, Ikeuchi T, Jia J, Wang H, Teunissen CE, Peskind E, Blennow K, Cummings J, Vergallo A. State-of-the-art of lumbar puncture and its place in the journey of patients with Alzheimer's disease. Alzheimers Dement 2021; 18:159-177. [PMID: 34043269 PMCID: PMC8626532 DOI: 10.1002/alz.12372] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023]
Abstract
Recent advances in developing disease‐modifying therapies (DMT) for Alzheimer's disease (AD), and the recognition that AD pathophysiology emerges decades before clinical symptoms, necessitate a paradigm shift of health‐care systems toward biomarker‐guided early detection, diagnosis, and therapeutic decision‐making. Appropriate incorporation of cerebrospinal fluid biomarker analysis in clinical practice is an essential step toward system readiness for accommodating the demand of AD diagnosis and proper use of DMTs—once they become available. However, the use of lumbar puncture (LP) in individuals with suspected neurodegenerative diseases such as AD is inconsistent, and the perception of its utility and safety differs considerably among medical specialties as well as among regions and countries. This review describes the state‐of‐the‐art evidence concerning the safety profile of LP in older adults, discusses the risk factors for LP‐associated adverse events, and provides recommendations and an outlook for optimized use and global implementation of LP in individuals with suspected AD.
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Affiliation(s)
- Harald Hampel
- Eisai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
| | - Leslie M Shaw
- Perelman School of Medicine, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Aisen
- USC Alzheimer's Therapeutic Research Institute, San Diego, California, USA
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alberto Lleó
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau-Biomedical Research Institute Sant Pau-Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsushi Iwata
- Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Asahimachi, Niigata, Japan
| | - Jianping Jia
- Innovation Center for Neurological Disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Elaine Peskind
- VA Northwest Mental Illness Research, Education and Clinical Center, VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, Nevada, USA
| | - Andrea Vergallo
- Eisai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
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5
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Mahmoudi K, Joon Y, Kihira S, Goldstein J, Garvey KL, Platt S, Belani P, Rigney B, Naidich T, Costa A, Doshi A. Body Mass Index Correlates with Skin to Spinal Canal Distance: A Large Retrospective Single-Center Study. J Neuroimaging 2020; 30:896-900. [PMID: 32639650 DOI: 10.1111/jon.12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Despite increasing demand for fluoroscopy-guided lumbar puncture (FG-LP), there is limited quantitative and epidemiological data on patients undergoing this procedure. Additionally, data are scarce on the correlation of iliac crest landmarks to the actual anatomical lumbar level (intercristal line). The aim of this study is to determine if (1) body mass index (BMI) correlates with skin to spinal canal distance (SCD) and (2) the iliac crest landmark correlates with the presumed anatomical landmark on cross-sectional imaging. METHODS In this retrospective, single-center IRB-approved study, we assessed 495 patients who underwent FG-LP and had lumbar computed tomography/magnetic resonance imaging within 6 months of presentation. SCD was measured on the sagittal view at the L3-L4, L4-L5, and L5-S1 intervertebral levels. RESULTS In our cohort of 495 adults (mean age ± standard deviation [SD], 53.2 ± 16.4 years), there was a statistically significant linear correlation between BMI and SCD at each intervertebral level. Mean ± SD (R2 ) SCD at L3-4, L4-5, and L5-S1 was 6.7 ± 1.6 cm (.5486), 7.4 ± 1.9 cm (.5894), and 7.8 ± 1.9 cm (.5968), respectively. The intercristal line aligned with L3-L4, L4-L5, and L5-S1 in 2.1%, 72.4%, and 6.2% of patients, respectively. CONCLUSIONS There was direct, positive linear correlation between BMI and SCD at clinically relevant lumbar disc levels. Furthermore, there is considerable anatomical variance in the intervertebral space that aligns with the superior aspect of the iliac crest.
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Affiliation(s)
- Keon Mahmoudi
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY
| | - Young Joon
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY.,Sinai BioDesign, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY
| | - Shingo Kihira
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY
| | - Jonathan Goldstein
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY
| | - Katherine Laura Garvey
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY
| | - Samantha Platt
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY
| | - Puneet Belani
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY
| | - Brian Rigney
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY
| | - Thomas Naidich
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY
| | - Anthony Costa
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY
| | - Amish Doshi
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY
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Remy KE, Verhoef PA, Malone JR, Ruppe MD, Kaselitz TB, Lodeserto F, Hirshberg EL, Slonim A, Dezfulian C. Caring for Critically Ill Adults With Coronavirus Disease 2019 in a PICU: Recommendations by Dual Trained Intensivists. Pediatr Crit Care Med 2020; 21:607-619. [PMID: 32420720 PMCID: PMC7331597 DOI: 10.1097/pcc.0000000000002429] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In the midst of the severe acute respiratory syndrome coronavirus 2 pandemic, which causes coronavirus disease 2019, there is a recognized need to expand critical care services and beds beyond the traditional boundaries. There is considerable concern that widespread infection will result in a surge of critically ill patients that will overwhelm our present adult ICU capacity. In this setting, one proposal to add "surge capacity" has been the use of PICU beds and physicians to care for these critically ill adults. DESIGN Narrative review/perspective. SETTING Not applicable. PATIENTS Not applicable. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The virus's high infectivity and prolonged asymptomatic shedding have resulted in an exponential growth in the number of cases in the United States within the past weeks with many (up to 6%) developing acute respiratory distress syndrome mandating critical care services. Coronavirus disease 2019 critical illness appears to be primarily occurring in adults. Although pediatric intensivists are well versed in the care of acute respiratory distress syndrome from viral pneumonia, the care of differing aged adult populations presents some unique challenges. In this statement, a team of adult and pediatric-trained critical care physicians provides guidance on common "adult" issues that may be encountered in the care of these patients and how they can best be managed in a PICU. CONCLUSIONS This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise.
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Affiliation(s)
- Kenneth E Remy
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - Philip A Verhoef
- Department of Internal Medicine, University of Hawaii-Manoa, Manoa, HI
- Kaiser Permanente Hawaii, Honolulu, HI
| | - Jay R Malone
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Michael D Ruppe
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Norton Healthcare, University of Louisville, Louisville, KY
| | - Timothy B Kaselitz
- Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Frank Lodeserto
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Danville, PA
- Department of Pediatrics, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Eliotte L Hirshberg
- Division of Pulmonary and Critical Care, Department of Internal Medicine and Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Anthony Slonim
- University of Nevada, Reno School of Medicine, Renown Health System, Reno, NV
| | - Cameron Dezfulian
- Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA
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7
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Valera-Calero JA, Laguna-Rastrojo L, de-Jesús-Franco F, Cimadevilla-Fernández-Pola E, Cleland JA, Fernández-de-las-Peñas C, Arias-Buría JL. Prediction Model of Soleus Muscle Depth Based on Anthropometric Features: Potential Applications for Dry Needling. Diagnostics (Basel) 2020; 10:diagnostics10050284. [PMID: 32392836 PMCID: PMC7277950 DOI: 10.3390/diagnostics10050284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/13/2020] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
This study was conducted to investigate if anthropometric features can predict the depth of the soleus muscle, as assessed with ultrasound imaging, in a sample of healthy individuals to assist clinicians in the application of dry needling. A diagnostic study to calculate the accuracy of a prediction model for soleus muscle depth, as assessed with ultrasonography, in the middle-third and distal-third of the calf, based on anthropometric features such as age, height, weight, body mass index (BMI), calf length, mid-third and distal-third calf girth, was conducted on 48 asymptomatic healthy subjects (75% male) involving a total of 96 calves. Multiple linear regression analyses were used to determine which variables contributed significantly to the variance in the soleus muscle depth at middle-third and distal-third of the calf by gender. Women were found to have a deeper soleus muscle than men (p < 0.001). Weight, height, BMI, and mid-third calf perimeter explained 69.9% of variance in men, whereas mid-third calf perimeter, calf length, height, and distal-third calf girth explained 73% of the variance in women of the distal-third soleus depth (p < 0.001). Additionally, mid-third calf girth and calf length explained 28.8% of variance in men, whereas mid-third calf perimeter, calf length, and weight explained 67.8% of variance in women of the mid-third soleus depth (p < 0.001). This study identified anthropometric features that predict soleus muscle depth, as assessed with ultrasound, in asymptomatic individuals, but these features are different in men and women. Our findings could assist clinicians in choosing the proper length of the needle to avoiding passing through the soleus during dry needling.
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Affiliation(s)
- Juan Antonio Valera-Calero
- Department of Physiotherapy, Faculty of Education and Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain;
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
- Correspondence: ; Tel.: +34-653-766-841
| | | | - Fernando de-Jesús-Franco
- Department of Pharmacy, Faculty of Health Sciences, Alfonso X el Sabio University, Villanueva de la Cañada, 28691 Madrid, Spain;
| | - Eduardo Cimadevilla-Fernández-Pola
- Department of Physiotherapy, Faculty of Education and Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain;
| | - Joshua A. Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02155, USA;
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain; (C.F.-d.-l.-P.); (J.L.A.-B.)
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28933 Madrid, Spain
| | - José Luis Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain; (C.F.-d.-l.-P.); (J.L.A.-B.)
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28933 Madrid, Spain
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Measurement of range of motions of L3-L4 healthy spine through offsetting reflective markers and in silico analysis of meshed model. Med Biol Eng Comput 2019; 57:2305-2318. [DOI: 10.1007/s11517-019-02026-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/31/2019] [Indexed: 12/12/2022]
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9
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Hudgins PA, Fountain AJ, Chapman PR, Shah LM. Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches. AJNR Am J Neuroradiol 2017; 38:1276-1283. [PMID: 28302612 DOI: 10.3174/ajnr.a5128] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Lumbar puncture has, for many years, been the responsibility of the internal medicine physician or the neurologist. 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. Radiology, in fact, is now the dominant overall provider of lumbar puncture procedures. 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. 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. 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.
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Affiliation(s)
- P A Hudgins
- From the Department of Radiology and Imaging Sciences (P.A.H., A.J.F.), Division of Neuroradiology, Emory University School of Medicine, Atlanta, Georgia
| | - A J Fountain
- From the Department of Radiology and Imaging Sciences (P.A.H., A.J.F.), Division of Neuroradiology, Emory University School of Medicine, Atlanta, Georgia
| | - P R Chapman
- Department of Radiology (P.R.C.), University of Alabama, Tuscaloosa, Alabama
| | - L M Shah
- Department of Radiology and Imaging Sciences (L.M.S.), University of Utah, Salt Lake City, Utah
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10
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Trends in Fluoroscopy Time in Fluoroscopy-Guided Lumbar Punctures Performed by Trainees Over an Academic Year. Acad Radiol 2017; 24:373-380. [PMID: 28110798 DOI: 10.1016/j.acra.2016.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Fluoroscopy-guided lumbar puncture (FGLP) is an operator-dependent procedure that can contribute to lifetime cumulative radiation dose. Benchmark fluoroscopic times (FTs) have been published for ranges of body mass index (BMI), but trends in FT in FGLPs performed by neuroradiology trainees during their training have not been studied. The purpose of this study was to investigate the trends in FTs in FGLPs performed by neuroradiology fellows in an academic year. MATERIALS AND METHODS We retrospectively reviewed FGLPs performed at our institution from July 2013 to June 2015 and determined the FT average and standard deviation of residents and non-neuroradiology fellows, neuroradiology fellows, and neuroradiology attendings. We used the Kruskal-Wallis test to evaluate group differences in FT in operator groups and academic quarters and by patient age, BMI, and needle length. Linear and Poisson regression analyses were performed to directly examine the relationship between the number of FGLPs performed and FTs. RESULTS A total of 776 patients had successful FGLPs; 594 cases (77%) were performed by neuroradiology fellows (n = 14). The average FT and variance for neuroradiology fellows significantly decreased over the year (P = 0.004 and P < 0.001) with an estimated decrease of 0.01 minute of FT per FGLP. BMI, long needle length, and age ≥65 years old significantly affected the average FT (P = 0.03, P < 0.001, and P < 0.001) and FT decreased in all of these subgroups in the academic year. CONCLUSIONS FT in FGLP cases performed by neuroradiology fellows decreases during the year. Our data can be utilized by radiology training programs and practices as a benchmark to monitor individual operator FT.
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