Fluoroscopic-guided lumbar puncture: fluoroscopic time and implications of body mass index--a baseline study.
OBJECTIVE
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.


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/m(2) and 1.07 minutes; 95% CI, 0.95-1.20) than in male patients (29.2 ± 7.3 kg/m(2) 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.
From the Divisions of Neuroradiology (S.R.B., A.C., R.P., A.M.S., P.A.H.) sboddu6@gmail.com.
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Boddu
From the Divisions of Neuroradiology (S.R.B., A.C., R.P., A.M.S., P.A.H.).
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Corey
From the Divisions of Neuroradiology (S.R.B., A.C., R.P., A.M.S., P.A.H.).
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Peterson
From the Divisions of Neuroradiology (S.R.B., A.C., R.P., A.M.S., P.A.H.).
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Saindane
From the Divisions of Neuroradiology (S.R.B., A.C., R.P., A.M.S., P.A.H.).
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Hudgins
Department of Biostatistics and Bioinformatics (Z.C., X.W.), Emory University, Atlanta, Georgia.
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Chen
Department of Biostatistics and Bioinformatics (Z.C., X.W.), Emory University, Atlanta, Georgia.
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Wang
Pediatric Radiology (K.E.A.), Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
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Applegate
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D013129:Spinal Puncture / Q000379:methods* / Q000592:standards*; D025321:Surgery, Computer-Assisted / Q000379:methods* / Q000592:standards*; D055815:Young Adult