PT  - JOURNAL ARTICLE
AU  - P.A. Hudgins
AU  - A.J. Fountain
AU  - P.R. Chapman
AU  - L.M. Shah
TI  - Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches
AID  - 10.3174/ajnr.A5128
DP  - 2017 Jul 01
TA  - American Journal of Neuroradiology
PG  - 1276--1283
VI  - 38
IP  - 7
4099  - http://www.ajnr.org/content/38/7/1276.short
4100  - http://www.ajnr.org/content/38/7/1276.full
SO  - Am. J. Neuroradiol.2017 Jul 01; 38
AB  - SUMMARY: Lumbar puncture has, for many years, been the responsibility of the internal medicine physician or the neurologist. As more patients have undergone spine surgery and with the current increase in body mass index of the general population, the radiologist has been consulted with increasing frequency to perform lumbar puncture with fluoroscopic guidance. Radiology, in fact, is now the dominant overall provider of lumbar puncture procedures. The procedure is more difficult when the needle length increases, and if fluoroscopy is used, landmarks are more difficult to visualize with increasing subcutaneous fat. Our goal with this review was to describe our techniques for lumbar puncture in the difficult patient, with emphasis on using fluoroscopy in the obese patient and to suggest maneuvers that might make the procedure easier. Combining our experience from performing these procedures on an obese population, we would like to share our tips, especially with trainees early in their career.BMIbody mass indexIIHidiopathic intracranial hypertensionLPlumbar puncture