A Prospective Observational Study Comparing Computer-Assisted Paramedian Approach Versus Conventional Midline Approach for Lumbar Puncture

Fujian Medical University (FJMU)

Status: Not yet enrolling

Conditions: Spinal Puncture

Treatments: Procedure: Conventional Midline Approach Technique; Procedure: Computer-Assisted Paramedian Approach Technique

Study type: Interventional

Funder types: Other

Identifiers

NCT06418841

ChiCTR2300067936

Details and patient eligibility

About

The goal of this clinical trial is to compare the effects of CMPAT and MAT in patients undergoing LP. Participants will be randomly assigned to either the CMPAT treatment group (group A) or the MAT treatment group (group B). Researchers will compare CMPAT treatment group and the MAT treatment group to see if the number of needle insertion attempts required for a successful LP, the puncture success rate, pain assessment in the back, head, and legs, and the occurrence of complications have different.

Enrollment: 84 estimated patients

Sex: All

Ages: 18 to 99 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Aged 18-99 years. Indication for lumber puncture (diagnostic lumbar puncture, analysis of cerebrospinal fluid composition, measurement of cerebrospinal fluid pressure, release of cerebrospinal fluid, lumbar cistern drain-age or intrathecal injection).

Body mass index between 18.5 and 35 kg/m2.

Exclusion criteria

• Cerebral hernia or known high cerebrospinal fluid pressure prone to cerebral hernia.
• Oral anticoagulant or antiplatelet therapy (≤3 days) or coagulation dysfunction, various factors lead to a higher risk of bleeding.
• Active infection or prior infection at the surgical site.
• Skin breakdown.
• Previous spine fusion surgery.
• Cauda equina syndrome.
• Pregnancy or breast feeding.
• Severe comorbid medical or psychiatric disorder.
• Unwilling to adhere to any of the required procedures.
• Cognitive impairment interfering with participant's ability to give full and - - informed consent or complete the baseline or follow-up assessments.
• Survival expectation less than 1 month.
• Moving abroad in 1 month.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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84 participants in 2 patient groups

Computer-Assisted Paramedian Approac Technique

Experimental group

Description:

The L3-4 inter-laminar space will be selected as the target for puncture, and in the longitudinal direction, 1.0-1.5cm will be opened beside the upper edge of the spinous process (tip) of the lower vertebra as the entry point. The lumbar puncture needle will be inserted vertically along the axis of the anesthesia needle. The puncture path will be maintained completely perpendicular to the skin until the needle reached the PLTLF (posterior layer of the thoracolumbar fascia), where some resistance will be felt. The puncture direction is adjusted as needed. The tip of the needle will be tilted 20±10° in the sagittal direction and 15±5° inward such that the tip will point at the midpoint of the spinal canal. After the needle reaches the PLTLF, it will be further inserted 3-7 cm.

Treatment:

Procedure: Computer-Assisted Paramedian Approach Technique

Conventional Midline Approach Technique

Experimental group

Description:

Puncture will be performed on the posterior median line near the midpoint of the L3-4 Space of spinous process. The lumbar puncture needle will be inserted vertically along the axis of the anesthesia needle, or the tip of the needle will be tilted 15° in the sagittal direction toward the head, so that the needle path is parallel to the space of spinous process.

Treatment:

Procedure: Conventional Midline Approach Technique