title: JOURNAL CLUB: Incidence of Complications Following Fluoroscopically Guided Lumbar Punctures and Myelograms.
abstract: OBJECTIVE
  Headaches due to CSF leak are a well-described complication of dural puncture. It is uncertain how long patients should be observed after dural puncture to reduce the risk of headache. Most of the literature has focused on dural punctures performed without fluoroscopic guidance. The purpose of this study was to determine the incidence of complications from fluoroscopically guided dural punctures, with attention to predictive factors such as the length of bed rest after the procedure.
  
  
  METHODS
  We retrospectively reviewed 2141 fluoroscopically guided dural punctures performed over a 5-year period by a single radiology practitioner assistant. All patients were contacted 48-72 hours after the procedure to assess for complications. Complications were categorized according to whether the patient reported having severe headache (requiring epidural blood patch for treatment), any headache, or any complaint. Using a multivariate logistic regression model, we assessed several possible predictors of complication: patient age, patient sex, needle caliber, puncture site, distance driven after recovery, length of postprocedural bed rest, contrast concentration, and contrast volume.
  
  
  RESULTS
  In all, 0.8% of patients reported having a severe headache, 2.2% reported having any headache, and 2.6% reported having any complaint. In the multivariate analysis, age and sex were predictive of complication rates (with younger women having higher rates), but the other variables were not predictive. In particular, length of postprocedural bed rest showed statistical equivalence.
  
  
  CONCLUSIONS
  Fluoroscopically guided dural punctures result in few complications compared with lumbar punctures performed without fluoroscopic guidance. Postprocedural bed rest greater than 2 hours does not reduce complication rates for fluoroscopically guided lumbar punctures.
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, PUH Rm D132, Pittsburgh, PA 15213.
authors.forename: David
authors.initials: D
authors.lastname: Rodriguez
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, PUH Rm D132, Pittsburgh, PA 15213.
authors.forename: Barton F
authors.initials: BF
authors.lastname: Branstetter
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, PUH Rm D132, Pittsburgh, PA 15213.
authors.forename: Vikas
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, PUH Rm D132, Pittsburgh, PA 15213.
authors.forename: Stacie
authors.initials: S
authors.lastname: Palfey
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, PUH Rm D132, Pittsburgh, PA 15213.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ching
authors.affiliation: 2 Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Bump
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, PUH Rm D132, Pittsburgh, PA 15213.
authors.forename: Marion A
authors.initials: MA
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001510:Bed Rest; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D006261:Headache / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000379:methods*; D009339:Needles; D011183:Postoperative Complications / Q000453:epidemiology*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013129:Spinal Puncture; D014195:Travel
chemical_list: D003287:Contrast Media
keywords: complication rates; fluoroscopy; headache; interventional radiology; lumbar puncture; myelogram