title: Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches.
abstract: Lumbar puncture has, for many years, been the responsibility of the internal medicine physician or the neurologist. As more patients have undergone spine surgery and with the current increase in body mass index of the general population, the radiologist has been consulted with increasing frequency to perform lumbar puncture with fluoroscopic guidance. Radiology, in fact, is now the dominant overall provider of lumbar puncture procedures. The procedure is more difficult when the needle length increases, and if fluoroscopy is used, landmarks are more difficult to visualize with increasing subcutaneous fat. Our goal with this review was to describe our techniques for lumbar puncture in the difficult patient, with emphasis on using fluoroscopy in the obese patient and to suggest maneuvers that might make the procedure easier. Combining our experience from performing these procedures on an obese population, we would like to share our tips, especially with trainees early in their career.
authors.affiliation: From the Department of Radiology and Imaging Sciences (P.A.H., A.J.F.), Division of Neuroradiology, Emory University School of Medicine, Atlanta, Georgia phudgin@emory.edu.
authors.forename: P A
authors.identifier: http://orcid.org/0000-0001-8816-4744
authors.initials: PA
authors.lastname: Hudgins
authors.affiliation: From the Department of Radiology and Imaging Sciences (P.A.H., A.J.F.), Division of Neuroradiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: A J
authors.identifier: http://orcid.org/0000-0002-9878-1161
authors.initials: AJ
authors.lastname: Fountain
authors.affiliation: Department of Radiology (P.R.C.), University of Alabama, Tuscaloosa, Alabama.
authors.forename: P R
authors.identifier: http://orcid.org/0000-0002-9296-5672
authors.initials: PR
authors.lastname: Chapman
authors.affiliation: Department of Radiology and Imaging Sciences (L.M.S.), University of Utah, Salt Lake City, Utah.
authors.forename: L M
authors.identifier: http://orcid.org/0000-0003-1303-3533
authors.initials: LM
authors.lastname: Shah
mesh_terms: D059925:Anatomic Landmarks; D005471:Fluoroscopy; D006801:Humans; D009339:Needles; D009765:Obesity / Q000000981:diagnostic imaging; D000070659:Patient Comfort; D015641:Radiography, Interventional; D013129:Spinal Puncture / Q000009:adverse effects* / Q000379:methods*; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed