Risk of intervertebral disc joint puncture during lumbar puncture

Ertas A. , Gediz T., Ozdol C., Gurses I. A. , ÖNDER M., ÜZEL M. , ...More

Clinical Neurology and Neurosurgery, vol.200, 2021 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 200
  • Publication Date: 2021
  • Doi Number: 10.1016/j.clineuro.2020.106107
  • Title of Journal : Clinical Neurology and Neurosurgery


© 2020 Elsevier B.V.Objective: Penetration of intervertebral disc joint during lumbar puncture might be unnoticed during procedure. However, accelerated degeneration of the disc joint is a long-term consequence of inadvertent penetration. In this paper, we aimed to demonstrate and evaluate the risk of disc puncture during standard lumbar puncture. Patients and Methods: 50 human cadavers were used in this study. Disc puncture risk was assessed by using worst case scenario model. Lumbar puncture was performed in a standard fashion using midline route at L3−4, L4−5 and L5-S1 levels. The needle was advanced until it hit resistance from the bone. Lateral X-ray was used to visualize the needle position. Needle ended up in two possible locations - posterior vertebral body wall and intervertebral disc space. Results: The probability of puncturing the joint was 20 % for L3−4, 38 % for L4−5, 16 % for L5-S1. Total probability of disc penetration was 25 %. Statistical analysis revealed significantly increased risk for performing LP at L4−5 level in comparison with L5-S1 (p = 0.023). Conclusion: Lumbar puncture carries significant risk of intervertebral disc penetration. This complication is not realized during the procedure and lead to accelerated joint degeneration.