Traditional landmark-based lumbar puncture as effective as ultrasound-guided LP in outpatient settings: UltraGUD LP study

The study found performer expertise and study settings to be important factors in a successful lumbar puncture. The researchers suggest further study of ultrasound use in specific populations with high BMI, prior back surgeries, and deformities of the spine.

In the realm of neurological procedures, lumbar puncture (LP) holds significant importance as a diagnostic tool for various neurological conditions. Over the years, the debate surrounding the optimal method for performing LP has sparked considerable interest among clinicians and researchers. Recently, a groundbreaking study titled "UltraGUD LP" shed light on this debate, presenting compelling evidence that challenges the conventional wisdom regarding LP techniques.

Lumbar puncture is a common neurologic procedure performed in inpatient and outpatient settings to obtain cerebrospinal fluid. Failure or success depends on several factors, including body mass index, age, spine anatomy, prior back surgery, technical aspects, and the performer's expertise.

Studies done in pediatrics, emergency departments, and anesthesia settings have shown mixed results with the overall superiority of ultrasound-guided technique. There is a lack of studies done in neurology to look at the benefits of ultrasound-guided LP over traditional LP in outpatient or inpatient settings.

In the “Ultra GUD LP - Ultrasound Guided Diagnostic Lumbar Puncture in Neurology” study, Vijay Renga, Geisel School of Medicine at Dartmouth, and colleagues compared the effectiveness of both techniques in an outpatient neurology setting.

For this purpose, the researchers performed a prospective randomized control study in clinic settings from 2017 to 2022. Subjects needing lumbar punctures from the outpatient neurology clinics were enrolled at the author's institution.

Following written informed consent, subjects were randomized into a traditional-landmark-based (n=23) or ultrasound-guided LP approach (n=12). The primary author performed all LPs similarly using a standard spinal needle.

The study led to the following findings:

• The average number of attempted procedures was 1.54 for the landmark group and 1.38 for the ultrasound group, which was not a significant difference.
• Ultrasound-guided LP was found to take an average of 6 minutes longer than the landmark method.
• A total of 3 subjects in each group developed post-LP headache, which, according to the Fisher exact test, does not suggest a significant association between headache and procedure type.
• There was no significant difference in outcomes across both procedure types in high-risk individuals, including those aged >50 years, those with a BMI >35, and those with a history of prior back surgery.

"Traditional landmark-based LP proved to be as effective as Ultrasound-guided LP in obtaining CSF with a similar success and complication rate with significantly less time taken in the study population," the researchers wrote.

Reference:

https://www.aan.com/msa/Public/Events/AbstractDetails/56688