Patient position during lumbar puncture has no meaningful effect on cerebrospinal fluid opening pressure in children.
The recommendation to measure cerebrospinal fluid opening pressure in the extended, rather than the flexed lateral recumbent position to avoid false elevation of the opening pressure has not been formally evaluated in children. This single-center prospective cohort study includes 53 children who had their opening pressure measured in both the flexed and extended lateral recumbent positions prior to removing any cerebrospinal fluid (mean age = 11.7 years; 60% male). The mean opening pressure was higher in the flexed (25.1 +/- 9.2 cm H2O) compared with the extended (24.4 +/- 8.4 cm H2O) position (mean difference = 0.6 +/- 2.2 cm H2O; Z = 2.021, P < .03). Most (92.4%) opening pressure measurements had less than a 5 cm H2O difference between positions. Lumbar puncture performed in the extended, rather than the flexed lateral recumbent position results in a statistically significant decrease in cerebrospinal fluid opening pressure, although the magnitude of the difference is small and of doubtful clinical significance.
Avery
Robert A
RA
Division of Neurology, Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA. averyr@email.chop.edu
Mistry
Rakesh D
RD
Shah
Samir S
SS
Boswinkel
Jan
J
Huh
Jimmy W
JW
Ruppe
Michael D
MD
Borasino
Santiago
S
Licht
Daniel J
DJ
Seiden
Jeffrey A
JA
Liu
Grant T
GT
D000293:Adolescent; D015170:Cerebrospinal Fluid Pressure; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011446:Prospective Studies; D013129:Spinal Puncture / Q000379:methods*