Percutaneous Access to the Subarachnoid Space—An Approach to the Patient With Difficult Body Habitus

Abstract

The needle technique for accessing the subarachnoid
space (SAS) was first described by German physician
Heinrich Quincke [1] in 1891. The popular Quincke spinal needle still bears his name.
The lumbar puncture is performed in the same manner
today as it was in the late 1800s, except with minor
modifications in equipment and technique. Our radiology department is regularly called upon to access the
SAS for both diagnostic and therapeutic indications, to
assess or treat such entities as follows:
1. Raised intracranial pressure
2. Suspected infection
3. Demyelinating disease
4. Disease progression or regression in neurooncology
5. Degenerative disc disease, for preoperative
assessment with myelography (usually in those
with a contraindication to magnetic resonance
imaging or in those patients with extensive
instrumented hardware causing significant artifact)
6. Intrathecal chemotherapy for patients with leukemia or lymphoma or metastatic disease
Despite advances in equipment and imaging, new challenges have arisen as the face of the world population
changes. The CDC estimates that more than one-third of
U.S. adults, and nearly, 17% of youth in America are
obese [2]. According to the national scoliosis foundation, 2–3% of the U.S. population is affected by scoliosis. Generalized edema in sick and hospitalized patients,
degenerative disk disease, spinal disorders such as ankylosing spondylitis, and a history of prior lumbar surgery
can also make an ordinarily simple procedure more challenging and time-consuming