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To the Editor: Dr Howard and colleagues¹ found that black children with acute lymphoblastic leukemia (ALL) had higher rates of traumatic lumbar puncture (LP) than did white children. They hypothesized that this was due to racial anatomical differences. Thus, they concluded that the risk of traumatic LP is "unmodifiable." In support of this hypothesis the authors cite research^2-3 involving approximately 140 bodies, half from a Swedish university forensics laboratory (white) and half from the Arkansas State Crime Laboratory (black). Such differences, however, may not necessarily be genetic. For example, a "black" from Arkansas might be subjected to more physical stress than a similar Swede. Furthermore, the research addresses areas of the spine other than the L4-L5 area pertinent to an LP (eg, the anterior ligament and the sacral transition angle).

Yet even if it were true that, on average, LPs were more difficult to perform in African American children, the . . . [Full Text of this Article]