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ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurotechnology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1521783
'UltraGUD LP' -Ultrasound Guided Diagnostic LP -A Randomized Controlled Trial: Traditional Landmark Based Lumbar Puncture is as effective as Ultrasound Guided Lumbar Puncture in Outpatient Neurology settings
Provisionally accepted- 1 Medical University of South Carolina, Charleston, South Carolina, United States
- 2 Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
Background: Lumbar puncture (LP) is a fundamental procedure in neurology, yet its success is influenced by patient anatomy and provider expertise. Ultrasound guidance has been shown to improve outcomes in emergency and anesthesia settings, but its effectiveness in outpatient neurology remains unclear.Objective: This study (UltraGUD LP) aimed to compare the effectiveness of ultrasound-guided LP (US-LP) versus landmark-based LP (LM-LP) in an outpatient neurology setting, performed by a single experienced provider.Methods: A prospective randomized controlled trial was conducted from 2017 to 2022. Patients requiring LP were randomized to either LM-LP or US-LP. Success was defined as obtaining cerebrospinal fluid (CSF) within three attempts. Secondary outcomes included procedure time, incidence of traumatic taps, and post-LP headache rates.Results: Both techniques had comparable success rates, with LM-LP achieving 91% and US-LP 100% (p > 0.05). Procedure time was significantly shorter for LM-LP (13 vs. 19 minutes, p < 0.05). The incidence of traumatic taps and post-LP headaches was similar between groups.In a general outpatient neurology population, LM-LP is as effective as US-LP and requires less time. While US-LP may be beneficial for high-risk patients (e.g., obesity, prior back surgery), further studies are needed to confirm its superiority in these populations.LM-LP remains a highly effective and efficient technique in outpatient neurology. US-LP offers potential benefits for high-risk populations but requires further study. Given the additional time and resource requirements, routine ultrasound use may not be justified for all patients.
Keywords: Lumbar Puncture, Landmark LP, Ultrasound LP, post LP headache, Traumatic tap
Received: 02 Nov 2024; Accepted: 13 Feb 2025.
Copyright: © 2025 Renga, Jeffreys, McKenzie and Tabassum. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Vijay Renga, Medical University of South Carolina, Charleston, 29425, South Carolina, United States
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