Factors influencing post-spinal puncture headaches or leaks
Garbett DL, Joshi MJ, Patel AR, Garbett TM. Factors influencing post-spinal puncture headaches or leaks. J Patient-Centered Res Rev. 2014;1:143.
Presented at 2014 Aurora Scientific Day, Milwaukee, WI
Background: Post-spinal puncture headache or leak is a well-known complication that occurs due to delay in dural defect repair. Identifying factors that increase the likelihood of such post-spinal puncture complications might be of benefit to decrease these adverse events. Several predisposing factors have been proposed including patient’s age, sex, smoking status, number of puncture attempts, etc.
Purpose: To assess whether spinal puncture at prior laminectomy site, patient age, needle gauge, needle type, training level of the physician, any prior spinal surgery, history of prior complications of spinal headaches or cerebrospinal fluid (CSF) leaks modifies the risk of getting post-spinal puncture headaches or leaks.
Methods: Incidence of spinal headaches or CSF leaks according to the aforementioned variables was determined by retrospective analysis of 557 patients at Aurora St. Luke’s Medical Center who had a spinal puncture for myelogram, spinal anesthesia, intrathecal chemotherapy, baclofen administration or CSF analysis. Fisher’s exact test was used to assess 2 × 2 tables, two-sample t-test was used to assess age, and binary logistic regression was used to assess needle gauge and physician training level. Binary logistic regression also was used for multivariate analysis of patient’s age and needle type.
Results: There were 11 reported cases of spinal headaches or CSF leaks out of 557 spinal punctures (1.97%). Younger age was associated with increased risk of complications post-spinal puncture (P=0.000). Whitaker needle was associated with decreased risk of complications (P=0.0496). Multivariate analysis demonstrated both age and needle type as significant independent predictors of complications (P=0.000 and P=0.021, respectively). None of the other variables, including prior spinal surgery, needle gauge, puncture at prior laminectomy site, physician training level or history of prior complications, were significant predictors of complication rates (P>0.05).
Conclusion: While post-spinal puncture complications were infrequent in our sample, there seem to be at least two factors that predict complication rates. Most notably, advanced age and the use of Whitaker needle were associated with reduced risk of post-spinal puncture headache or leak as compared to younger patients and use of Quinke needle.