Risk of Spinal Hematoma After Lumbar Puncture

To the Editor The recently published article by Dr Bodilsen and colleagues reported the association between lumbar puncture and spinal hematoma in patients with coagulopathy. When interpreting their results, some issues should be considered. First, this study defined spinal hematoma based on diagnosis codes regarding spinal hematoma –related symptoms or treatments. The diagnosis of spinal hematoma should be based on neuroimaging data, including magnetic resonance imaging and computed tomographic scan results since diagnosis codes without regard to neuroimaging data may cause a misdiagnosis of spinal hematoma. Second, the loca tion of lumbar puncture–related spinal hematoma was not mentioned in this article. The location of spinal hematoma (eg, lumbar, cervical, thoracic, epidural, intradural, subarachnoid) may affect the outcome of spinal hematoma so should have be included in this study. Third, because differentiating traumatic spinal tap from subarachnoid hemorrhage can be difficult in clinical practice, the authors should have more clearly stated how these conditions were distinguished. Fourth, this article did not include cases with failed attempts of lumbar puncture. Among patients with successful lumbar pun cture, some may have to undergo multiple attempts, which can be associated with higher risk of lumbar puncture–related injury. Fifth, although not mentioned in this study, in clinical practice, some patients may have more than 1 coagulation disorder, such as th...
Source: JAMA - Category: General Medicine Source Type: research