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Role of routine use of ultrasonographic guidance for performing lumbar punctures
  1. Sujay Halkur Shankar1,
  2. Sagnik Biswas1,
  3. Arvind Kumar1,
  4. Akshita Gupta1,
  5. Aastha Goel1,
  6. Maroof Ahmad Khan2,
  7. Rajesh Kumar Singh3,
  8. Piyush Ranjan1,
  9. Manish Soneja1,
  10. Naveet Wig4
  1. 1Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
  3. 3Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
  4. 4Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Arvind Kumar, Department of Medicine, All India Institute of Medical Sciences, New Delhi, DL 110029, India; linktoarvind{at}


Purpose of study Ultrasound (US) for lumbar puncture has seen the most success in obese patients and in patients with difficult to palpate landmarks. We aimed to elucidate the advantage of the use of routine US for performing lumbar punctures over the traditional landmark method.

Study design This was a prospective study with consecutive sampling with a sample size of convenience. Three residents were chosen to perform the lumbar punctures after a training session. Patients were assigned to either the US group or the landmark group. The outcomes studied were number of attempts at needle insertion, patient and physician anxiety, pain experienced, time to procedure, number of traumatic attempts and the difficulties faced during the procedure.

Results A total of 77 patients were included in this study, of which 36 patients (46.8%) underwent landmark-based lumbar puncture and 41 (53.2%) underwent US-guided lumbar puncture. There was no statistically significant difference between the two groups among the following characteristics: number of attempts to a successful procedure, number of traumatic punctures, procedure time, preprocedure anxiety of the participants and physicians and pain score rating of the procedure.

Conclusion There was no significant difference between the landmark method and US-guided method for performing lumbar puncture in the number of successful attempts, number of traumatic punctures, procedure time and pain during the procedure. Further studies are required to elucidate the advantage of the use of ultrasonography in subsets of the population such as the low body mass index population.

  • neurology
  • medical education & training
  • adult neurology
  • ultrasonography

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  • Contributors All authors were all involved in study design and execution. Data were collected by SHS, SB, AkG and AaG. Statistical analysis was done by MAK. The article has been drafted by SHS and SB under the guidance of AK, RKS, PR, MS and NW.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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