From the Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
From the Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
AJNR Am J Neuroradiol. 2023 Jun;44(6):722-729. doi: 10.3174/ajnr.A7867. Epub 2023 May 11.
Important information regarding fluoroscopically guided lumbar puncture (FGLP) performance and referrals is lacking. The purpose of our study was to elucidate the success rate for initial FGLP attempts and re-attempts, reasons for unsuccessful FGLPs, and the relationship between clinical indications and whether patients will undergo a fluoroscopically guided re-attempt, among others.
This retrospective study analyzed failed FGLP attempts in hospitalized adult patients at an academic hospital between June 2016 and March 2022. Unsuccessful FGLPs were labeled as insufficient CSF egress. FGLP reports and patients' clinical charts were analyzed for pertinent information such as clinical indication, reason for failure, whether patients received IV fluid before fluoroscopically guided spinal puncture attempt, and which patients returned for another FGLP attempt. Patients' ages and sex were analyzed using descriptive statistics. The OR was used to investigate the relationship between the clinical indications to perform FGLP and whether patients returned for a re-attempt.
Sixty-three of 1389 (4.5%) patients (median age, 62 years) had failed the initial FGLPs administered by 39 trainees. Twenty-eight of 63 (44.4%) patients (median age, 64 years) underwent a re-attempt within a median of 2 days after the first attempt, and 27/28 (96.4%) re-attempts were successful. A dry tap, no egress of CSF was the top reason (58.7%) for failed FGLP, and 12/13 of patients had a successful FGLP after IV hydration. Twenty-seven of 63 (43%) patients did not undergo a repeat attempt, and 100% were subsequently discharged from the hospital. There was no difference ( > .05) in the likelihood of patients returning for a repeat FGLP based on the clinical indications.
Initial and repeat FGLPs have very high success rates. No difference exists in the likelihood of patients returning for a re-attempt based on clinical indication.
缺乏有关荧光引导腰椎穿刺（FGLP）操作和转介的重要信息。我们的研究目的是阐明首次 FGLP 尝试和再次尝试的成功率、FGLP 失败的原因，以及临床指征与患者是否接受荧光引导再次尝试之间的关系等。
这项回顾性研究分析了 2016 年 6 月至 2022 年 3 月在一家学术医院住院的成年患者中失败的 FGLP 尝试。未成功的 FGLP 被标记为脑脊液流出不足。分析了 FGLP 报告和患者的临床图表，以获取相关信息，如临床指征、失败原因、患者在荧光引导脊髓穿刺尝试前是否接受静脉补液，以及哪些患者返回进行另一次 FGLP 尝试。使用描述性统计分析患者的年龄和性别。使用 OR 来研究进行 FGLP 的临床指征与患者是否返回进行再次尝试之间的关系。
1389 例患者（中位年龄 62 岁）中有 63 例（4.5%）首次 FGLP 失败，由 39 名学员进行操作。63 例患者中有 28 例（44.4%）在首次尝试后中位数 2 天内进行了再次尝试，其中 27/28（96.4%）再次尝试成功。干抽，无脑脊液流出是 FGLP 失败的首要原因（58.7%），12/13 例患者静脉补液后 FGLP 成功。63 例患者中有 27 例（43%）未进行重复尝试，100%随后出院。根据临床指征，患者再次进行 FGLP 的可能性没有差异（>.05）。
首次和再次 FGLP 的成功率非常高。患者是否返回进行再次尝试的可能性与临床指征无关。
