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8%), followed by spinal abnormalities (51.5%), and history of ≥ 5 previous LPs (33.3%). Age less then 12 months and history of back surgery were also associated with difficult LPs, but at a lower frequency. On the basis of these findings, we propose clinical recommendations for preprocedural identification of patients at risk of difficult LPs to reduce complications, including TLP, failure, and exposure to general anesthesia. Children with Down syndrome (DS) have delayed development and atypical movements including kicking. We hypothesi
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