Lumbar puncture is an important procedure in the early stages of MS when other causes need to be ruled out. And in the course of MS LP can help establish whether drugs work or not, for example by measuring the level of specific proteins in the cerebro-spinal fluid. The PROXIMUS trial of oxcarbazepine on top of an immunomodulatory drug is an example (and still open for new participants!).
With good technique and use of a local anaesthetic there is usually very little pain involved in the procedure itself. However, a common problem is so called 'post-lumbar puncture headache syndrome', a dreadful positional headache usually lasting a few days until it spontaneously resolves. The syndrome is due to the small leak of spinal fluid that remains after withdrawing the spinal tap needle.
Atraumatic (pencil tip, top) and traumatic (cutting) needles
It has been clear for decades that the risk of this syndrome can be significantly reduced by using a non-cutting (atraumatic) instead of the traditional cutting (traumatic) LP needle. Despite numerous studies in favour of atraumatic needles, however, their use remains the exception rather than the norm.
In this review we explore the reasons for such poor uptake of an evidently useful change in practise. We hypothesize the poor uptake by neurologists of atraumatic needles has virtually nothing to do with the evidence, but all with poor communication among clinicians, between seniors and juniors, commissioners, and people about to undergo an LP not knowing there are alternatives between needle systems used. For anyone about to have an LP we have produced a simple website summarizing the key information.
Atraumatic needles for lumbar puncture: why haven't neurologists changed?
Davis A, Dobson R, Kaninia S, Giovannoni G, Schmierer K.
Diagnostic lumbar puncture is a key procedure in neurology; however, it is commonly complicated by post-lumbar puncture headache. Atraumatic needle systems can dramatically reduce the incidence of this iatrogenic complication. However, only a minority of neurologists use such needles. In this paper, we discuss possible reasons why neurologists have not switched to new technology, looking more at diffusion of innovation rather than lack of evidence. We suggest ways to overcome this failure to adopt change, ranging from local interventions to patient empowerment.
CoI: This is work by Barts MS.