Comparison of atlantoaxial and lumbosacral cerebrospinal fluid centesis techniques in South American camelids.
Authors: Malmström Ester, Cole Robert C, Hofmeister Erik H, Stern Jere K, Passler Thomas
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Atlantoaxial vs Lumbosacral CSF Collection in South American Camelids Blood contamination during cerebrospinal fluid centesis frequently compromises diagnostic interpretation, prompting investigation of alternative collection sites. Malmström and colleagues conducted a single-blinded crossover study in eight healthy camelids to evaluate whether ultrasound-guided atlantoaxial (AA) puncture—a technique previously described in horses—might offer advantages over the conventional lumbosacral (LS) approach in terms of sample quality and technical feasibility. Both techniques successfully yielded diagnostic samples without complications, with median red blood cell counts of 167.5/μL (AA) and 155/μL (LS), total nucleated cell counts of 1/μL and 0.5/μL respectively, and total protein concentrations of 32.9 mg/dL (AA) versus 38 mg/dL (LS)—differences that were not statistically significant. Although AA centesis required a median of one needle repositioning event compared to none for LS, both techniques required only one attempt on average, indicating comparable technical ease. These findings suggest that ultrasound-guided AA centesis represents a viable alternative to lumbosacral collection in camelids, offering clinicians flexibility depending on patient presentation, concurrent pathology affecting the lumbosacral region, or operator preference, though the anticipated advantage in reducing blood contamination was not demonstrated in this healthy population.
Read the full abstract on PubMed
Practical Takeaways
- •Ultrasound-guided atlantoaxial CSF collection is a viable alternative to lumbosacral centesis in camelids, offering clinicians another option for diagnostic sampling
- •Neither technique demonstrated superior sample quality in terms of reduced blood contamination, so technique selection can be based on clinician preference and animal positioning
- •Both techniques were successful on first attempt in most cases, suggesting ultrasound guidance makes either approach reliable for practitioners
Key Findings
- •Ultrasound-guided atlantoaxial centesis was technically feasible in South American camelids with success in all 32 collection attempts and no complications
- •Atlantoaxial and lumbosacral centesis techniques yielded comparable CSF analyte concentrations, with median total nucleated cell counts of 1/μL (AA) vs 0.5/μL (LS) and red blood cell counts of 167.5/μL (AA) vs 155/μL (LS)
- •Technical difficulty did not differ significantly between techniques, with median 1 attempt required for both and median needle repositioning of 1 for AA versus 0 for LS
- •Total protein concentration was slightly lower with atlantoaxial centesis (32.9 mg/dL) compared to lumbosacral (38 mg/dL)