Why, How Often, and What Happens When We Fail: A Retrospective Analysis of Failed Fluoroscopically Guided Lumbar Punctures

BACKGROUND AND PURPOSE: 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.

MATERIALS AND METHODS: 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.

RESULTS: 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 (P > .05) in the likelihood of patients returning for a repeat FGLP based on the clinical indications.

CONCLUSIONS: 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.