IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711
Int J Clin Exp Med 2013;6(2):149-152

Case Report
Use of ultrasound to facilitate difficult lumbar puncture in the pediat-ric oncology

Shantanu Warhadpande, David Martin, Tarun Bhalla, Saif Rehman, Melissa Rose, Terri Guinipero, Joseph D Tobias

The Ohio State University College of Medicine, Columbus; Department of Anesthesiology & Pain Medicine, Nationwide Children’s
Hospital; Department of Pediatrics & the Division of Pediatric Hematology/Oncology, The Ohio State University, Columbus, Ohio

Received December 18, 2012; Accepted January 2, 2013; Epub January 26, 2013; Published February 6, 2013

Abstract: In the pediatric hematology-oncology population, lumbar punctures (LP’s) are commonly performed to administer intrathecal
chemotherapy and obtain CSF samples. Difficult LP’s can arise due to obesity, fibrous tissue formation due to repeated LP
procedures, or spinal abnormalities. For difficult LP’s that require imaging-guidance, fluoroscopy is generally?? Fluoroscopy, however,
subjects the patient and healthcare providers to radiation while also potentially increasing procedure cost and time. We retrospectively
studied the utility of ultrasound-guidance to facilitate LP in 4 pediatric hematology-oncology patients. All 4 patients had a history of
difficult LP and 3 of 4 had previously required use of fluoroscopy. With the use of ultrasound, the LP was successfully performed in all 4
patients with one attempt (number of attempts not recorded in one patient). Procedure time was less than 20 minutes in all 4 patients.
Our preliminary data suggests that ultrasound may be an efficacious alternative to fluoroscopy. By using ultrasound to identify the
landmarks in the lumbar region, the appropriate puncture point can be determined allowing access to the intrathecal space with
relative ease. This would decrease the need for fluoroscopy-guidance, the incidence of multiple punctures as well as reducing the
procedure time and costs. (IJCEM1212005).

Keywords: Ultrasound, diagnosis, difficult lumbar puncture, pediatric, oncology

Address correspondence to: Dr. Tarun Bhalla, Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700
Children’s Drive, Columbus, Ohio 43205. Phone: (614)-7224200; Fax: (614)-7224203; E-mail: Tarun.Bhalla@Nation-widechildrens.org