Failure of Oblique Needle Insertion to Prevent Post-Lumbar Puncture Headache

To the Editor.  —Post-lumber puncture headache (PLPH) remains a significant problem in clinical practice, occurring after approximately 30% of lumbar punctures (LPs).¹ Over 40 different factors that might influence the incidence of PLPH have been considered by as many authors. Despite the voluminous literature, there remains a lack of convincing evidence of a relationship with any of these factors, apart, perhaps, from needle size, for which the data are reasonably strong in favoring the use of smaller needles.²It has been suggested by Thorsen³ that the hole produced by an oblique or tangential insertion of the needle should heal faster than that produced when the needle is inserted perpendicularly. Hatfalvi⁴ reported no headaches in a personal series of 600 spinal anesthetics, and he attributed this to his preferred technique of lateral or oblique insertion of the spinal needle. His explanation for this finding was that the dural and arachnoid holes did