INCIDENCE OF POSTLUMBAR PUNCTURE SYNDROME REDUCED BY REINSERTING THE STYLET - A RANDOMIZED PROSPECTIVE-STUDY OF 600 PATIENTS

The post-lumbar puncture syndrome (PLPS) can best be explained by prol onged spinal fluid leakage owing to delayed closure of a dural defect. Its incidence after spinal anaesthesia is much lower than after diagn ostic lumbar puncture (LP). This difference could be caused by a stran d of arachnoid, which might enter the needle with the outflowing cereb rospinal fluid (CSF) during diagnostic LP and upon removal of the need le be threaded back through the dura to produce prolonged CSF leakage. To find a technique that further reduces the incidence of PLPS, this hypothesis was tested by evaluating the effect that reinserting the st ylet before removing the needle had on the incidence of PLPS. By reins erting the stylet to the tip of the needle, the hypothesized strand wo uld be pushed out, thereby reducing the frequency of PLPS. Sprotte's ' 'atraumatic needle'' (21 gauge) was used for LP. A total of 600 patien ts participated in the prospective study. They were randomized into tw o groups and questioned about their complaints every day for up to 7 d ays after the LP. All LPs were performed by two experienced neurologis ts (T.B., M.S.), In 300 patients, the stylet was reinserted to the tip of the needle; in the other 300 it was not reinserted. Whereas 49 of the 300 patients without reinsertion developed PLPS, only 15 of the 30 0 patients with reinsertion did. This significant difference (16.3 vs 5.0%, P < 0.005, chi square test) supports our hypothesis. On the basi s of our results, we recommend reinserting the styler before removing the needle in order to reduce the incidence of PLPS.