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Figure 1. Side profile of cutting spinal needles. (A) Bier (1899). (B) Corning (1900). (C) Quincke-Babcock (1914), with matching stylet. (D) Pitkin (1927), with matching stylet. (E) Kirshner (1932), closed tip and lateral orifice. (F) Rovenstine (1944), closed tip with matching stylet and lateral orifice. White: open orifice; red: stylet.
(Figure omitted. See article PDF.)
Figure 2. Side profile of cutting spinal needles. (A) Levy (1957), with stylet tip. (B) Distal taper (1960s), with matching stylet. (C) Atraucan® (1993), with double bevel and matching stylet. Red: stylet.
(Figure omitted. See article PDF.)
Figure 3. Pencil-point spinal needles. (A) Whitacre (1951). (B) Gertie Marx (1985). (C) Sprotte (1987). (D) Eldor (1996). (E) Ballpen (2000), with stylet as needle tip. Note: all pencil-point spinal needles have a stylet (not shown, except in (E) , as demarked in red).
(Figure omitted. See article PDF.)
"Searing and spreading like hot molten metal, the head pain was all consuming, the lights surreal and too bright, and the only sound that I could hear through the ringing wooliness was my own screaming. My head. Please help me..."[1].
Seemingly lifted from a medieval text on pain and suffering, this contemporary account is from a previously healthy patient who underwent a spinal puncture for the pain relief during childbirth. The resulting headache, termed a postdural puncture headache (PDPH) from the hole created in the dural tissues, is produced through a loss of cerebral spinal fluid (CSF) and subsequent tension on meningeal structures; when severe, the treatment of choice is the injection of the patient's own blood into the epidural space forming a patch over the dural puncture, that is, an epidural blood patch (EBP). The incidence of PDPH, as well as the ability to safely and reliably perform the technical aspects of a dural puncture, is directly related to the design of the spinal needle. This review will focus on the design modifications applied to spinal needles to maximize their clinical utility and minimize their side effects.
Early needles & the hypodermic syringe
Although the discovery of spinal anesthesia in 1885 is credited to the New York neurologist J Leonard Corning, the achievement was dependent on the development of needles, and more specifically, needles that could be attached to syringes (Table...