Ultrasound-Guided Lumbar Puncture Not Superior to Traditional Landmark-Based Approach According to Study at AAN 2024
Ultrasound guidance did not significantly affect the outcomes of lumbar puncture (LP) performed by a single experienced practitioner in the outpatient setting. According to data from the UltraGUD LP clinical trial (NCT03815045), which were presented at the American Academy of Neurology (AAN) 2024 Annual Meeting, traditional landmark-based LP was as effective as ultrasound-guided LP and was less time-consuming. The results of this study differ from other findings in pediatric, emergency department (ED), and anesthesia populations, which have previously suggested that ultrasound guidance was a superior method of LP.
UltraGUD LP was a prospective, randomized control study conducted from 2017 to 2022 that included 35 adult participants who required LP at outpatient neurology clinics. Participants were randomly assigned to receive either landmark-based LP (n=23) or ultrasound-guided LP (n=12). Both types of LP procedure were performed by Vijay Renga, MD, Assistant Professor of Neurology at the Geisel School of Medicine at Dartmouth, using a regular spinal needle.
The average number of attempted procedures was 1.54 for the landmark group and 1.38 for the ultrasound group, which was not a significantly difference (P=.0443, Wilcoxon Rank test). Ultrasound-guided LP was found to take an average of 6 minutes longer than the landmark method (P=.02, Wilcoxon Rank test). A total of 3 subjects in each group developed post LP headache, which, according to the Fisher exact test, does not suggest a significant association between headache and procedure type (P=.648). Additionally, there was no significant difference in outcomes across both procedure types in high-risk individuals, including those aged >50 years, those with a BMI >35, and those with a history of prior back surgery.
The study authors suggest that the practitioner’s more extensive experience using the landmark method may have impacted study results and that further research should be conducted for high-risk individuals. The study authors are affiliated with the Geisel School of Medicine at Dartmouth.