Low incidence of postdural puncture headache further reduced with atraumatic spinal needle: a retrospective cohort study

Abstract Objective To evaluate the incidence of postdural puncture headache (PDPH) in a predominantly pediatric sample before and after a transition from conventional to atraumatic spinal needles. Study Design In this retrospective cohort study, we analyzed data from 1,059 lumbar puncture (LP) procedures in 181 individuals enrolled in NIH Clinical Center research protocols. Multivariate logistic regression was used to evaluate the association between PDPH and spinal needle type after adjusting for patient age, sex and BMI. A random effect of participant was used to accommodate repeated observations. Results The median age at time of procedure was 15.3 years. The overall rate of PDPH was 5.1% (54/1,059). With conventional needles and atraumatic needles respectively, the rate of PDPH was 7.7% (43/588) and 2.3% (11/471); (odds ratio 0.32, 95% CI 0.15 - 0.68). Conclusion Lumbar puncture for collection of cerebrospinal fluid is an essential and common procedure in pediatric clinical care and research. PDPH is the most common adverse event of the LP procedure. Our data indicate that LP is safe in pediatrics and that use of an atraumatic spinal needle further reduces the risk of PDPH.