Why, How Often, and What Happens When We Fail: A Retrospective Analysis of Failed Fluoroscopically Guided Lumbar Punctures

American Journal of Neuroradiology

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FIG 1.
Breakdown of reasons for unsuccessful FGLPs. DJD indicates degenerative joint disease.
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FIG 2.
Breakdown of patients with initial dry taps who returned for repeat FG spinal punctures.
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FIG 3.
Outcomes of patients with initial failed FGLPs due to an inability to follow commands and/or pain and anxiety.
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FIG 4.
Flowchart to determine how to prepare for and perform an FG spinal puncture. PO indicates by mouth.
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FIG 5.
Flowchart for patients who return for a repeat FG spinal puncture.

Table 1:

Breakdown of data on failed and repeat spinal punctures

Reason for Initial FGLP Failure (No.)	No. of Patients Who Returned for a Repeat Spinal Puncture/No. of Patients with Initial FGLP Failure	No. of Successful Repeat Spinal Punctures/No. of Patients Who Returned for a Repeat Spinal Puncture Attempt
Lack of egress of CSF in the LP needle confirmed in the spinal canal (n = 37)	15/37 (40.5%)	14/15 (93.3%)
Degenerative changes (n = 8)	2/8 (25%)	2/2 (100%)
Patient’s inability to follow commands and/or due to pain and anxiety (n = 10)	6/10 (60%)	6/6 (100%)
High BMI (n = 3)	1/3 (33%)	1/1 (100%)
Patient in lateral decubitus position (n = 2)	2/2 (100%)	2/2 (100%)
Postsurgical scarring or instrumentation (n = 2)	1/2 (50%)	1/1 (100%)
Unknown (n = 1)	1/1 (100%)	1/1 (100%)
Total (n = 63)	28/63 (44%)	27/28 (96%)

Table 2:

Factors associated with whether the patient will return for a repeat FGLP and the reason for the failed LP

	Unadjusted OR (95% CI)
Factors
Age	0.99 (0.96–1.02)
Sex (male/female)	0.7 (0.25–1.86)
Lumbar levels attempted (>1 vs 1)	0.84 (0.31–2.28)
Resident year	1.04 (0.7–1.54)
Clinical indication (infection or neoplasm vs other)	0.55 (0.19–1.52)
Reason for failed LP
Cannot enter spinal canal vs dry tap	0.77 (0.24–2.37)
Cannot enter spinal canal vs other^{^a}	1.74 (0.48–6.66)