spinal puncture

The label for Fragmin contains a boxed warning to alert health care professionals and patients that epidural or spinal hematomas (accumulation of blood that can mechanically compress the spinal cord) may occur in patients who are anticoagulated due to taking certain medications called low molecular weight heparins (LMWH) or heparinoids and are receiving neuraxial anesthesia (injection near the spine) or undergoing spinal puncture (removing spinal fluid for testing).

Multiple factors are involved in the pathogenesis of postoperative back pain and include type and duration of surgery, duration of immobilisation, and the position of the patient during spinal puncture. Diagnosis of back pain is not simple; contributing factors may include needle trauma, surgical positioning and injection of saline or local anaesthetic into the interspinous ligaments, development of a supraspinous haematoma, excessive stretching of ligaments after relaxation of paraspinal muscles and localised trauma to the intervertebral disc.

Spinal puncture was done using 25 G needle at L3-L4 space and drugs were given after confirming CSF aspiration.

We accessed four databases (the American Academy of Neurology, The Cochrane Library, PubMed, CINAHL) and used several search strings: "spinal puncture, post lumbar, dural, postdural, puncture, needle"; "headache, back pain, backache"; "bed rest, posture, immobilization, early ambulation"; and "caffeine/therapeutic use." We reviewed articles from 2005 to 2012 and examined some references of selected studies to deeply investigate some aspects.

Bleeding disorders may increase the risk of spinal hematoma related to spinal puncture. Spinal hematoma may in turn result in spinal cord compression and permanent paralysis.

Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors.

Conclusion: Spinal puncture should not be performed higher than the L3-L4 intervertebral space in Chinese patients having low backache unless the position of the lower end of the spinal cord is identified by prior MRI.