title: [Possibility of cauda equina nerve root damage from lumbar punctures performed with 25-gauge Quincke and Whitacre needles].
abstract: OBJECTIVE
  To assess the possibility of puncturing nerve roots in the cauda equina with spinal needles with different point designs and to quantify the number of axons affected.
  
  
  METHODS
  We performed in vitro punctures of human nerve roots taken from 3 fresh cadavers. Twenty punctures were performed with 25-gauge Whitacre needles and 40 with 25-gauge Quincke needles; half the Quincke needle punctures were carried out with the point perpendicular to the root and the other half with the point parallel to it. The samples were studied by optical and scanning electron microscopy. The possibility of finding the needle orifece inserted inside the nerve was assessed. On a photographic montage, we counted the number of axons during a hypothetical nerve puncture.
  
  
  RESULTS
  Nerve roots used in this study were between 1 and 2.3 mm thick, allowing the needle to penetrate the root in the 52 samples studied. The needle orifice was never fully located inside the nerve in any of the samples. The numbers of myelinized axons affected during nerve punctures 0.2 mm deep were 95, 154, and 81 for Whitacre needles, Quincke needles with the point held perpendicular, or the same needle type held parallel, respectively. During punctures 0.5 mm deep, 472, 602, and 279 were affected for each puncture group, respectively. The differences in all cases were statistically significant.
  
  
  CONCLUSIONS
  It is possible to achieve intraneural puncture with 25-gauge needles. However, full intraneural placement of the orifice of the needle is unlikely. In case of nerve trauma, the damage could be greater if puncture is carried out with a Quincke needle with the point inserted perpendicular to the nerve root.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital General de Móstoles, Madrid. miguelangel.rei@terra.es
authors.forename: M A
authors.initials: MA
authors.lastname: Reina
authors.forename: A
authors.initials: A
authors.lastname: López
authors.forename: M C
authors.initials: MC
authors.lastname: Villanueva
authors.forename: J A
authors.initials: JA
authors.lastname: De Andrés
authors.forename: S
authors.initials: S
authors.lastname: Martín
mesh_terms: D002420:Cauda Equina / Q000293:injuries*; D004867:Equipment Design; D006801:Humans; D008875:Middle Aged; D009339:Needles; D013129:Spinal Puncture / Q000295:instrumentation*