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    Pediatric Emergency Medicine physicians at Boston Medical Center are reporting that lumbar puncture (LP), commonly known as a spinal tap, may in rare cases cause continuing headaches, backaches, and other neuromuscular problems in children.

    Exactly how often headaches and backaches affect adults after LP is questionable; estimates are wide-ranging, from less than one percent to 37 percent, due to lack of information in this area. Information about children undergoing LP is even more scarce because children can't explain the specifics of their pain very well, even if they are old enough to talk

    Additionally, LPs are not a routine test, and they are invasive. Therefore it's extremely difficult to set up controlled research studies that are the hallmark of evidence-based medicine.

    In this report, physicians from Boston, Massachusetts, and Washington, DC, describe three cases where children, ages six, 10, and 15, came to the emergency room (ER) and required a lumbar puncture for diagnosis. They were found to have aseptic meningitis, viral meningitis, and Lyme disease respectively. Their headaches, backaches, numbness, and inability to sit or stand upright lasted for 18 days, six days, and more than six weeks, respectively.

    All three returned to the ER because of their continuing symptoms and magnetic resonance imaging (MRI) was done. In all cases, the MRI showed that cerebrospinal fluid (CSF) had leaked from the normally closed system and had collected in the space around the spinal cord. The fluid was pressing on the nerve roots, and this was presumed to be the cause of the continuing pain and neuromuscular problems.

    Lumbar punctures are frequently ordered for children who come to the ER with certain sets of symptoms, but no clear diagnosis. The physicians acknowledge that the complications described above are very rare and are not recommending that this valuable test not be done. The purpose of this report is to let physicians and parents know that through the use of MRIs, these physicians have found that sometimes a lumbar puncture can cause a local accumulation of CSF that may cause continuing symptoms in children.



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