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Lumbar Puncture

A lumbar puncture is a procedure in which a needle is inserted into the lower back so that it reaches the fluid-filled spinal canal. In the spinal canal is also the delicate spinal cord. There are other names for the lumbar puncture, including a spinal puncture, thecal puncture, spinal tap or rachiocentesis. It is a procedure most often done to diagnose a particular disease by collecting a sample of fluid from around the spinal cord and evaluating the fluid in the laboratory.

In some cases, a spinal cord is done in order to treat a disease. Cancer drugs, anesthetics and antibiotics can be given via this route and spinal fluid may be removed for purposes of treating an elevated pressure in the spinal fluid. These include reducing spinal fluid in cases of benign intracranial hypertension and normal pressure hydrocephalus.

The lumbar spinal tap is usually done with a patient lying on their left side with the back pushed out and the knees slightly flexed. In some cases, it can be done with the patient in the seated, upright position with the back pushed out.

A local anesthetic is injected into the skin around where the spinal tap is going to be performed. A needle is inserted in a direction slightly toward the head and between the spinous processes. It is then pushed through the skin so that it reaches the spinal canal. It is usually done between the third and fourth lumbar vertebrae. The provider then measures the pressure in the spinal canal and takes out some cerebrospinal fluid or CSF to be tested in the laboratory.

The cerebrospinal fluid is the fluid that circulates around the brain and bathes the spinal cord. It supports these structures and creates buoyancy for them. It protects the cerebrospinal system from being injured. It contains several molecules, including sugar and protein. It has a specific pressure which is measured before any spinal fluid is taken out.

The spinal fluid usually contains between 15 and 45 mg/dl of protein and between 50 and 75 mg/dl of glucose. It has a cell count of less than five and a pressure of between 70 and 180 mm Hg. Disease or illness can change these values. The cerebrospinal fluid is also Gram stained and cultured for the presence of infection.

There are several diseases that can be diagnosed with a lumbar puncture. It can identify bleeding around the brain and increased pressure in hydrocephalus. It can identify inflammation of the brain or nearby tissues and can show tumors of the cerebrospinal syndrome. Multiple sclerosis can also be diagnosed via this method.

There are complications of a lumbar puncture including severe headache, bleeding in the spinal canal, brain herniation and cerebrospinal infection. Headache is the most common complication of a lumbar puncture but can be reduced if the patient lies flat for at least 1-3 hours following the procedure. The headache, if it occurs, can be treated by doing a blood patch. It is performed by injecting a small amount of blood around the leaking area where the tap was done. The blood coagulates, stopping the leakage.

The needle can become in connection with the spinal canal roots and can lead to paresthesias, usually of the leg. These paresthesias are usually transient in nature and pass after a few minutes. Another complication is an epidural or spinal hemorrhage. This can lead to paraplegia, which is the worst complication of this procedure. In addition, infection can be introduced into the spinal canal from bacteria found on the skin.

While there are risks and complications of a spinal tap, it is often considered to be a lifesaving procedure, especially in cases of spinal or brain infection.