Spinal epidermoid tumours following neonatal lumbar puncture: A review of the evidence

Abstract

background: Spinal epidermoid tumours have long been recognized as a possible consequence of using hollow spinal needles to perform lumbar punctures in neonates. Studies from the 1950s were among the earliest to describe such tumours and to show that they can be caused by fragments of epithelium inserted into the epidural or subarachnoid space. Methods: A review of the relevant published literature and a survey of the needle choice of paediatricians working at the Orillia Soldiers' Memorial Hospital (Orillia, Ontario), as well as all final-year residents in paediatrics at the University of Toronto (Toronto, Ontario), was performed. Results: Approximately 35 cases of post-lumbar puncture spinal epidermoid tumours have been reported in the literature since 1972, a rate of approximately one per year. The majority of the reported cases were associated with the use of needles without a stylet and were discovered years after the lumbar puncture(s). The number of reported tumours has decreased since the first half of the 20th century; this is believed to be due to the use of smaller-gauge disposable needles in the modern era. Of the physicians surveyed, 66% of staff paediatricians used needles with stylets initially, but switched to regular needles if unsuccessful; 86% of final-year paediatric residents surveyed did not use stylets due to their perceived greater success rate with regular needles. Discussion: Despite these trends in needle choice, use of a stylet remains an important consideration when performing a lumbar puncture due to the continued occurrence of spinal epidermoid tumours. Additional research is required to determine the optimum needle type for this common neonatal procedure. ©2013 Pulsus Group Inc. All rights reserved.