1619. Lumbar Puncture increases risk of Lumbar Degenerative Disc Disease: Analysis from the Rochester Epidemiology Project (REP)

Authors: Mohamad Bydon, MD, FAANS ; F M Moinuddin, PhD; Mohammed Ali Alvi, MBBS; Frank D. Ryan, MS (Rochester, MN)

Introduction: Disc degeneration disease (DDD) is one of the most common causes of low back pain. Etiology of DDD is not completely understood and has been reported to be multi-factorial; some common factors include ageing, biomechanical loading and several molecular and genetic factors. Lumbar puncture (LP) is a commonly performed procedure for delivering spinal anesthetic drugs. The association between LP and DDD has not been investigated. Herein, we report our results from a case control study using the Rochester Epidemiology Project (REP).

Methods: REP was queried for patients that underwent an LP procedure in Olmsted County, Minnesota between 2004 to 2009. The outcome of interest was DDD. For each patient that underwent an LP, 2 control patients (those without a history of LP) were identified in REP after matching for age, sex, and Body Mass Index. Univariate as well as Cox proportional hazards analyses were used to estimate the risk of DDD among patients undergoing LP.

Results: A total of 950 cases and 1876 controls were identified for the study period. DDD was diagnosed in 20.5% (n=195) patients in the LP group compared to 16.4% (n=308) in the Non-LP group, which corresponded to an incident rate ratio of DDD of 1.37 (95%CI 1.14-1.64) for LP group. The cumulative probability of developing DDD from the time of LP procedure was 13.8% among LP cases (95%CI 11.5%-16.1%) vs. 9.4% among controls (95%CI 8.1%-10.8%) at 5 years. On multivariable Cox regression analysis, patients undergoing an LP were found to have a significantly higher risk of developing DDD (HR1.33; 95%CI 1.10-1.60; p=0.003); this risk was significantly higher among younger patients (<40 years group: HR 1.53; 95%CI 0.96-2.44).

Conclusion: These results indicate that patients undergoing an LP procedure may be at higher risk of developing DDD. Further studies are required to corroborate these results.