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Effect of Patient Positioning on Cerebrospinal Fluid Opening Pressure

Abel, Anne S. MD; Brace, Jeffrey R. MD; McKinney, Alexander M. MD; Friedman, Deborah I. MD, MPH; Smith, Scott D. MD, MPH; Westesson, Per L. MD, DDS, PhD; Nascene, David MD; Ott, Frederick MD; Lee, Michael S. MD

doi: 10.1097/WNO.0000000000000074
Original Contribution

Background: Prone is the preferred patient position for fluoroscopic-guided lumbar puncture (LP). Normative data for cerebrospinal fluid (CSF) opening pressure (OP) exist for lateral decubitus (LD) positioning only and have not been defined for the prone position. This study compares CSF OP values in the prone and LD positions and examines the effect of body mass index (BMI) on OP.

Methods: Patients undergoing diagnostic or therapeutic fluoroscopic-guided LP were recruited prospectively at 2 tertiary care centers from 2009 to 2012. Following prone fluoroscopic-guided LP, patients were rolled to the LD position for repeat CSF OP measurement. In addition to comparing the mean OP in each position, the relationships between OP, body position, and BMI were also explored.

Results: Fifty-two patients were enrolled. A mean OP difference of 1.2 cm H2O was observed (prone: 26.5 cm H2O; LD: 27.7 cm H2O; P = 0.07). No correlation between CSF OP and BMI was seen in either position.

Conclusions: No statistically or clinically significant difference between prone and LD OP was identified. BMI does not appear to affect CSF OP measurement in either position.

Departments of Ophthalmology (ASA, MSL), Neuroradiology (JRB, AMM, DN, FO), Neurosurgery (MSL), and Neurology (MSL), University of Minnesota, Minneapolis, Minnesota; Departments of Neurology and Neurotherapeutics (DIF) and Ophthalmology (DIF), University of Texas Southwestern, Dallas, Texas; Department of Ophthalmology (SDS), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; and Department of Imaging Sciences (PLW), University of Rochester, Rochester, New York.

Address correspondence to Michael S. Lee, MD, 420 Delaware Street SE, MMC 493, Minneapolis, MN 55455; E-mail:

Supported by an unrestricted grant from Research to Prevent Blindness (New York, NY) and the Lions Club of Minnesota (M.S.L.).

The authors report no conflicts of interest.

© 2014 by North American Neuro-Ophthalmology Society