To the Editor: Dr Howard and colleagues1 found that black children with acute lymphoblastic
leukemia (ALL) had higher rates of traumatic lumbar puncture (LP) than did
white children. They hypothesized that this was due to racial anatomical differences.
Thus, they concluded that the risk of traumatic LP is "unmodifiable." In support
of this hypothesis the authors cite research2,3 involving
approximately 140 bodies, half from a Swedish university forensics laboratory
(white) and half from the Arkansas State Crime Laboratory (black). Such differences,
however, may not necessarily be genetic. For example, a "black" from Arkansas
might be subjected to more physical stress than a similar Swede. Furthermore,
the research addresses areas of the spine other than the L4-L5 area pertinent
to an LP (eg, the anterior ligament and the sacral transition angle).
Vachon GC. Racial Differences in Rates of Traumatic Lumbar PunctureRacial Differences in Rates of Traumatic Lumbar Puncture. JAMA. 2003;289(5):548. doi:10.1001/jama.289.5.548