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Gertie Marx Needles in Transforaminal Lumbar Puncture for Spinal Anesthesia

The Gertie Marx atraumatic spinal needle is praised by physicians and medical scholars throughout the country. Known for their unmatched precision, tactile control, and enhanced feedback, these spinal needles thrive in both teaching environments and in real application. In a recent study entitled Transforaminal lumbar puncture for spinal anesthesia or novel drug administration: a technique combining C-arm fluoroscopy and ultrasound, Gertie Marx needles were utilized with great success.


Dr. Charles Berde, Dr. Anna Formanek, Dr. Asif Khan, Dr. Carlos Rafael Camelo, Dr. Anjali Koka, and Dr. Bobbie L Riley (Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Department of Anaesthesia, Harvard Medical School), and Dr. Horacio Padua (Department of Radiology, Boston Children’s Hospital, Department of Radiology, Harvard Medical School) conducted this study with institutional review board approval.


Below we will go over some of the most notable findings.


Background and Methods for Transforaminal Lumbar Puncture for Spinal Anesthesia

Physicians may find it difficult to approach lumbar puncture (LP) for patients with scoliosis or other conditions that come as a result of previous posterior fusion and instrumentation from thoracic to sacral levels. As such, Dr. Charles Berde, Dr. Anna Formanek, Dr. Asif Khan, Dr. Carlos Rafael Camelo, Dr. Anjali Koka, Dr. Bobbie L Riley, and Dr. Horacio Padua hypothesized that a feasible approach to transforaminal LP for interventional pain physicians and regional anesthesiologists would be combined C-arm fluoroscopy and ultrasound.


With this in mind, medical records and imaging of six patients with spinal muscular atrophy and prior spine fusion were reviewed, totaling in 54 transforaminal LPs at Boston Children’s Hospital. At first, they utilized 17.8 cm needles for interlaminar LP (the longest needles available to the hospital at the time). The needle was not long enough to reach the dura, so the procedure was aborted.


Then, the physicians identified the Gertie Marx 25-gage non-cutting spinal needles, available in lengths of 19.0 or 221.5 cm. According to the study, “Because these needles are so long and thin, it became apparent that standard 20-gage 3.2–3.8 cm introducer needles commonly used for routine spinal anesthesia were insufficient to prevent needle deflection from the intended path.



With the Gertie Marx needles, the physicians were able to successfully reach the dura.


Results and Conclusions for Transforaminal Lumbar Puncture for Spinal Anesthesia

“Six patients underwent a total of 54 transforaminal LPs, including 51 for administration of the antisense oligonucleotide nusinersen, 2 for myelography, and 1 for spinal anesthesia; 45 of these procedures were performed using OR C-arm fluoroscopy and ultrasound. Transient paresthesias and short-term headaches occurred; none required intervention. No other complications were noted.


Transforaminal LP appears technically feasible for patients with full-spine fusions using a straight-needle approach with combined fluoroscopy and ultrasound guidance. Larger case series and prospective studies may better define the success rates, risks, and benefits of this approach relative to alternative approaches to intrathecal access for patients with previous long-segment posterior spine fusions.”


Gertie Marx Atraumatic Spinal Needles

IMD Corp is proud to be a continuous resource in the advancement of patient care, medical technique, and overall physician development. Engineered to provide increased precision, tactile control and enhanced feedback, the Gertie Marx needle dramatically reduces the risk of PDPH. The unique “pop” of the Gertie Marx needle penetrating the dura also sets the standard for improving first time results in teaching environments.


If your hospital is experience backorder issues from your spinal needle provider, we are here to help. Gertie Marx needles are fully stocked, with orders shipping within 24 hours! Contact us here to place an order.