Spinal epidermoid tumours following neonatal lumbar puncture: A review of the evidence
Bibliographic record
Abstract
Spinal epidermoid tumours have long been recognized as a possible consequence of using hollow spinal needles to perform lumbar punctures in neonates. Studies from the 1950s were among the earliest to describe such tumours and to show that they can be caused by fragments of epithelium inserted into the epidural or subarachnoid space. A review of the relevant published literature and a survey of the needle choice of paediatricians working at the Orillia Soldiers’ Memorial Hospital (Orillia, Ontario), as well as all final-year residents in paediatrics at the University of Toronto (Toronto, Ontario), was performed. Approximately 35 cases of post-lumbar puncture spinal epidermoid tumours have been reported in the literature since 1972, a rate of approximately one per year. The majority of the reported cases were associated with the use of needles without a stylet and were discovered years after the lumbar puncture(s). The number of reported tumours has decreased since the first half of the 20th century; this is believed to be due to the use of smaller-gauge disposable needles in the modern era. Of the physicians surveyed, 66% of staff paediatricians used needles with stylets initially, but switched to regular needles if unsuccessful; 86% of final-year paediatric residents surveyed did not use stylets due to their perceived greater success rate with regular needles. Despite these trends in needle choice, use of a stylet remains an important consideration when performing a lumbar puncture due to the continued occurrence of spinal epidermoid tumours. Additional research is required to determine the optimum needle type for this common neonatal procedure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".