LP MEDICOLEGAL

Online. Updated Aug 07, 2019.

Know your anatomy Pediatric LP in wrong interspace costs defendants $10 million Facts: A mother videos her 1 year old daughter taking her very first steps. The next day the child sees her pediatrician for a scheduled intrathecal chemotherapy injection for her acute lymphoblastic leukemia. Shortly thereafter her mother notes that her daughter is fussy and moving her legs very little. On further evaluation she is diagnosed with partial paraplegia due to a spinal cord injury. She is now wheelchair-bound and undergoes at least one surgery and to improve her mobility, and will likely need more. A lawsuit is filed. Plaintiff: The LP for the injection was done at the T12-L1 level. That's at least 2 levels higher than the standard of care, because the spinal cord extends to at least the L2-3 level at her age. You injected a chemotherapeutic agent either into - or too close to - her spinal cord. Even her own doctors agree. Now she can't play like the other kids, knows she's different and is frustrated. Defense: Even though she has partial paraplegia, she's a bright child. She will be able to adapt to her limitations and attend school, college, work and raise a family. Result: Pre-trial settlement for $10 million against health system and pediatric physician group after 2 years of litigation. Takeaways: * LP must be done distal to the spinal cord at the level of the cauda equina. * At birth, the distal end of the spinal cord is at L3. In adults, the tip of the spinal cord is at L1. * Below 12 months an LP must be performed below the L2-L3 interspace. * In older children and adults, LP can be done from L2-L3 to the L5-S1 interspace. * Know your anatomy. * Know your anatomy even better when you're doing a pediatric LP. * Know your anatomy even better yet when you're injecting a toxic drug through the needle. * Find the right interspace, go there - and only then - go there. Source: Family of baby paralyzed after medical treatment gets $10 million settlement. Krell A. Tacoma News-Tribune, Jan 20, 2020. Reference: Lumbar puncture: Indications, contraindications, technique, and complications in children. Fastle RK. UpToDate Online. Last updated Mar 25, 2019.

Medicine is a science of uncertainty and an art of probability. William Osler