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A New Way to Do Lumbar Puncture?

January 24, 2020

Written by Clay Smith

Spoon Feed
The SAIL technique* was superior to the usual landmark using the intercristal line to find the L4-L5 interspace in pregnant patients.

Why does this matter?
The classic landmark for LP is the intercristal line – the invisible line across the top of the posterior superior iliac crests that is supposed to mark the L4-L5 interspace. But is this the best way to find the space? This may be especially difficult in patients with increased intracellular fluid, such as pregnant patients. Is the SAIL technique a more accurate way to find L4-L5?

Smooth SAILing
This was an open-label RCT including 110 women who were ≥37 weeks pregnant. They compared the intercristal line technique with the SAIL technique, with ultrasound as the gold standard for the location. The SAIL technique found the L4-L5 space 49% of the time; the intercristal line was accurate just 8% of the time. Of course, ultrasound is another great way to find the space and was the gold standard in this study.

*Sacral anatomical interspace landmark (SAIL) technique – palpate the dorsal and distal sacrum, slide in a cranial direction to palpate the L5-S1 interspace and then slide up one more.

Sacral anatomical interspace landmark for lumbar puncture in pregnancy: A randomized trial. Neurology. 2019 Dec 12. pii: 10.1212/WNL.0000000000008749. doi: 10.1212/WNL.0000000000008749. [Epub ahead of print]

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What are your thoughts?