Atraumatic lumbar puncture needles after all these years, are we still missing the point?

Abstract

Modern cutting needles, also called Quincke needles, have an obliquely sliced tip that cuts through the dura. The pencil-point or atraumatic needle was thought to penetrate and then separate the dural fibers, resulting in a less traumatic hole and subsequent less loss of CSF and a lower incidence of PDPH.

The rate of PDPH for diagnostic lumbar puncture in an ambulatory population with a 20- or 22-gauge cutting needle is estimated to be 36%. In comparison, the rate of PDPH with a 22-gauge atraumatic needle is estimated to be less than 2%. The superiority of the atraumatic needle has also been demonstrated in a randomized trial for myelography, with fewer postmyelogram headaches observed with an atraumatic needle compared with a cutting tip design.

Conclusions

The evidence that atraumatic spinal needles cause fewer PDPHs is so convincing that both the American Society of Anesthesiologists (ASA) and the American Academy of Neurology have published statements encouraging the replacement of cutting needles by atraumatic spinal needles.

Expressed differently, this evidence reveals that for every 6 neurology patients that undergo a diagnostic dural puncture with an atraumatic needle instead of a standard needle, 1 patient will get a headache.

Further, studies looking specifically at neurology patients undergoing lumbar puncture have shown a decrease from 36% to ~3%.

The use of noncutting or pencil-point spinal needles should become the standard for performing diagnostic lumbar puncture.