Lumbar puncture: Anatomical review of a clinical skill

Clinical Anatomy - Tập 17 Số 7 - Trang 544-553 - 2004
J.M. Boon1, Peter Abrahams2, J.H. Meiring1, T. Welch3
1Department of Anatomy, Unit of Clinical Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
2Kigezi International School of Medicine, Cambridge, Girton College, Cambridge, United Kingdom, St. George’s University Grenada and St. Vincent, West Indies.
3Kigezi International School of Medicine, Cambridge, Queen's College, Cambridge, United Kingdom

Tóm tắt

AbstractThe safe and successful performance of a lumbar puncture demands a working and specific knowledge of anatomy. Misunderstanding of anatomy may result in failure or complications. This review attempts to aid understanding of the anatomical framework, pitfalls, and complications of lumbar puncture. It includes special reference to 3D relationships, functional and imaging anatomy, and normal variation. Lumbar puncture is carried out for diagnostic and therapeutic purposes. Epidural and spinal anesthesia, for example, are common in obstetric practice and involve the same technique as diagnostic lumbar puncture except that the needle tip is placed in the epidural space in the former. The procedure is by no means innocuous and anatomical pitfalls include inability to find the correct entry site and lack of awareness of structures in relation to the advancing needle. Headache is the most common complication and it is important to avoid traumatic and dry taps, herniation syndromes, and injury to the conus medullaris. With a thorough knowledge of the contraindications, regional anatomy and rationale of the technique, and adequate prior skills practice, a lumbar puncture can be carried out safely and successfully. Clin. Anat. 17:544–553, 2004. © 2004 Wiley‐Liss, Inc.

Từ khóa


Tài liệu tham khảo

Abrahams PH, 1975, Clinical anatomy of practical procedures, 13

Adams RD, 1997, Principles of neurology, 13

10.1002/(SICI)1098-2353(1999)12:1<43::AID-CA7>3.0.CO;2-W

Association of American Medical Colleges, 1998, Learning objectives for medical student education. Guidelines for medical schools, 5

Beahrs OH, 1986, Gross anatomy in medical education, Am Surg, 52, 227

10.1053/rapm.2003.50129

10.1007/s00276-001-0057-3

10.1046/j.1365-2044.2000.01547-4.x

10.1001/jama.1958.03000030033008

10.1007/BF02133005

Bromage PR, 1993, A‐loss‐of‐resistance‐to‐negative‐pressure test for subarachnoid puncture with narrow‐gauge needles, Reg Anesth, 18, 155

10.1046/j.1365-2044.2000.01157.x

10.1002/(SICI)1098-2353(1999)12:1<55::AID-CA8>3.0.CO;2-O

Cousins MJ, 1988, Neural blockade in clinical anesthesia and management of pain, 324

10.1136/pgmj.65.762.221

Dalens BJ, 1990, Pediatric regional anesthesia, 354

Domisse GF, 1975, The arteries and veins of the human spinal cord from birth, 81

10.1136/bmj.1.5641.407

Ellis H, 1997, Anatomy for anesthetists, 108

Fitzgerald MJT, 1978, Human embryology: a regional approach, 68

General Medical Council, 1993, Tomorrow's doctors: recommendations on undergraduate medical education, 1

General Medical Council, 2002, Good medical practice: guidance from the General Medical Council, 3

10.1002/ca.980060604

10.1002/(SICI)1098-2353(1996)9:3<173::AID-CA8>3.0.CO;2-H

Gleason CA, 1983, Optimal position for a spinal tap in preterm infants, Paediatrics, 71, 31, 10.1542/peds.71.1.31

10.1136/jnnp.50.8.1071

10.1002/(SICI)1098-2353(1996)9:1<61::AID-CA14>3.0.CO;2-8

Hawass ND, 1987, Myelographic study of the spinal cord ascent during fetal development, Am J Neuroradiol, 8, 691

10.1097/00000542-199111000-00007

10.1007/BF03019206

10.1093/bja/66.3.381

10.1080/01421599978988

Kopacz DJ, 1996, The regional anesthesia “learning curve”: what is the minimum number of epidural and spinal blocks to reach consistency?, Reg Anesth, 21, 182

10.1212/WNL.42.10.1884

10.1001/jama.248.18.2308

10.1093/bja/67.6.690

10.1002/(SICI)1098-2353(1999)12:3<149::AID-CA1>3.0.CO;2-X

10.1001/archneur.1986.00520090064019

McMinn RMH, 1984, A colour atlas of applied anatomy

10.1177/000992288602501008

Moore KL, 1993, The developing human: clinically oriented embryology, 392

10.1002/(SICI)1098-2353(1999)12:5<375::AID-CA7>3.0.CO;2-6

10.1213/00000539-199409000-00022

10.1016/0304-3959(87)90017-0

Parkin IG, 1985, The topographical anatomy of the lumbar epidural space, J Anat, 141, 211

10.1097/00007632-198003000-00003

10.1111/j.1526-4610.1990.hed3004197.x

10.1046/j.1365-2044.2000.01830.x

Reynolds F, 2001, Damage to the conus medullaris following spinal anesthesia, Anaesthesia, 56, 235, 10.1046/j.1365-2044.2001.01422-2.x

10.1002/ar.1090880108

10.1097/00007632-199807010-00005

10.1111/j.1365-2044.2001.2279-39.x

10.1111/j.1526-4610.1972.hed1202073.x

Van Dellen JR, 1978, Lumbar puncture—an innocuous diagnostic procedure?, S Afr Med J, 53, 666

Vettivel S, 1991, Vertebral level of the termination of the spinal cord in human fetuses, J Anat, 179, 149

Wall EJ, 1990, Organization of intrathecal nerve roots at the level of the conus medullaris, J Bone Joint Surg Am, 72, 1495, 10.2106/00004623-199072100-00010

Weisman LE, 1983, The effect of lumbar puncture position in sick neonates, Am J Dis Child, 137, 1077

10.7326/0003-4819-116-12-1091

Williams PL, 1989, Gray's anatomy, 1123

Thông tin
Thông tin xuất bản

Clinical Anatomy

Tập 17 Số 7

544-553

Thông tin tác giả