To the Editor.—
We agree with Drs Eng and Seligman (1981;245:1456) that lumbar puncture itself can introduce blood-containing organisms into the subarachnoid space and thus cause bacterial meningitis in a patient without preexisting meningeal infection. Although the size of spinal needles used in the selected cases were not mentioned, we have commonly observed diagnostic lumbar punctures performed with 20-gauge needles. Certainly the use of a smaller needle would decrease the incidence of vessel puncture and contamination. The use of a 22-gauge spinal needle allows for satisfactory CSF sampling and opening pressure movements; in addition, lumbar puncture with a 25-gauge needle can provide adequate CSF sampling. Patients to be studied commonly have a coagulopathy, and vessel puncture may lead to major neurological sequelae.2 Finally, post-lumbar puncture headaches may complicate any ongoing neurological assessment, and the incidence of this type of headache is greater with a 20-gauge spinal needle (8%)3
Spielman FJ, Wolf S. The Advantages of Small-Gauge Spinal Needles. JAMA. 1982;247(3):304. doi:10.1001/jama.1982.03320280026012
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