1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-2-69-a 10.15844/pedneurbriefs-2-9-7 Infectious Disease Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Nontraumatic Lumbar Puncture http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 09 1988 01 08 2016 2 9 69 69 Copyright: © 1988 The Author(s) 1988 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Estimating lumbar-puncture depth in children

A technique and formula for avoiding the traumatic spinal tap is reported from the Medical College of Wisconsin, Milwaukee, WI.

 Traumatic Spinal Tap Traumatic Puncture Lateral Decubitus Position

A technique and formula for avoiding the traumatic spinal tap is reported from the Medical College of Wisconsin, Milwaukee, WI. To increase the accuracy and to minimize the frequency of traumatic puncture, the authors conducted a 12-month prospective analysis of 158 children of various ages in whom this diagnostic procedure was performed during the evaluation of an acute illness. The right lateral decubitus position was used and the needle was inserted perpendicularly in the L-3 to L-4 vertebral interspace. After CSF was collected, the needle was marked at the skin line and the length inserted was measured. The patient’s age, weight, and height were used to calculate the body-surface area in square meters. The body-surface area showed the highest correlation with the depth of lumbar puncture. Linear regression for surface area provided a simple formula to estimate the depth of puncture to within 5 mm in young children of all ages:

Depth = 0.77 cm + 2.56 (m2) [1]

COMMENT. Insertion of the needle too deeply with puncture of venous plexuses in the anterior wall of the vertebral wall is the most common error. The avoidance of traumatic lumbar puncture by the use of this simple calculation and formula should facilitate the diagnosis of meningitis and reduce the risk of iatrogenic meningitis resulting from blood contamination of a previously sterile CSF in the patient with bacteremia. The authors are to be congratulated on their attempt to introduce some mathematical accuracy into a commonly “hit or miss“ procedure.

 Bonadio WA Smith DS Metrou M Dewitz B Estimating lumbar-puncture depth in children N Engl J Med 1988 Oct 6 319 14 952 3 10.1056/NEJM198810063191416 3419463