A Guide to a Lumbar Puncture Procedure

Overview

 A lumbar puncture is a laboratory test in which a needle is inserted between your lumbar vertebrae i.e., bones in the lower region of your spine or lumbar region. It is a rather painless experience but some dull pain can be expected. A lumbar puncture is used for either the extraction from e.g., extraction of the cerebrospinal fluid (CSF) or insert material into the spine. It is also known as spinal tap and this article will reflect upon some of the basic information about this test.  

Indications

A lumbar puncture is a very useful test for the diagnosis of a lot of conditions. It is indicated in a number of situations for example:  

  • Suspicion of infections – these can include bacterial, viral, and fungal infections. It is the most important diagnostic test for meningitis. 
  • Suspicion of subarachnoid haemorrhage (bleeding) – especially in cases of negative CT scan. 
  • Taking samples of fluid from the spine, also called cerebrospinal fluid, to diagnose a condition 
  • Measuring the CSF pressure  
  • Inject medicine – such as painkillers, antibiotics, and chemotherapy. Inject a spinal anaesthetic – An example would be during labour. In this situation, the anaesthetic is inserted into the pregnant woman’s spine to number all feelings from the waist down so that she does not feel the pain of labour. This epidural may also be used before an operation e.g., a caesarean section. 
  • Draining cerebrospinal fluid to decrease pressure in the skull and spine. 

Risks of Procedure

A lumbar puncture involves one of the most sensitive organs of the body – the brain and spinal cord. Therefore, there is a risk of complications that may follow the puncture. These complications include: 

  • A small amount of cerebrospinal fluid may leak out of the wound possibly causing a headache. If too much seeps out, the headache can become severe. 
  • An infection can be possible as you have broken the natural skin barrier. 
  • A feeling of numbness in the lower back and legs for some time. 
  • Inability to urinate – this might happen if one of your spinal nerves gets damaged during the procedure 
  • Some bleeding in the spinal canal 

There may be other risks that can happen depending on everyone’s specific situation. 

Medical gallery of Blausen Medical 2014. WikiJournal of Medicine CC BY 3.0 https://creativecommons.org/licenses/by/3.0, via Wikimedia Commons

Patient Preparation

You may be contacted by a nurse or physician a few days prior to your lumbar puncture to discuss the procedure. During the discussion, a few questions may be asked by your physician including: 

  • If you are taking any antibiotics – if you are taking an antibiotic course for an infection in your blood, the lumbar puncture may be delayed for due to the possibility of an active infection and fever.  
  • If you are allergic to local anaesthetics like lidocaine 
  • If you may be pregnant  
  • If you are on any anticoagulant therapy such as taking blood thinners like aspirin 

You would be advised to increase your fluid uptake up to two days before the procedure. However, on the day of the procedure, you do not eat up to the time of the procedure but may have liquids and permitted medications.  

You must either clothe in very loose clothing for easy access to your spine or may have to change into a loose-fitting gown right before the procedure. You may also have to bring an adult driver to accompany you because you may not be able to drive back yourself. A cab or taxi would not be considered an escort.  

Procedure

A lumbar puncture takes between thirty to forty-five minutes and follows some general steps as follows: 

  1. Removing clothing, jewellery, and other objects that may interfere with the procedure 
  2. You will be given a gown to wear  
  3. You must empty your bladder before the procedure starts  
  4. During the puncture you may lie on your side on the exam table with chin tucked to your chest and knees tucked to your abdomen.  
  5. Another position that is also used is sitting on the edge of the exam table with arms over a table positioned in front of you. In both positions, the back is arched and helps widen the space between the vertebrae.  
  6. Your back will be cleansed with an antiseptic solution and the healthcare provider will be using sterile gloves.  
  7. The hollow needle is inserted into the locally numb area of the spine into where the CSF is located.  
  8. It is absolutely necessary for you to remain still as any movement may cause pain or complications. 
  9. The cerebrospinal fluid will be collected slowly into test tubes.  
  10. In the case of medication, the medicine will be injected as the CSF is collected. 
  11. When the procedure is done, the needle will be removed and a bandage will be placed on top of the injection site.  

Some discomfort may assume after the procedure. Make sure to inform your physician of your feelings after the procedure so that comfort-inducing methods may be used to rid of any long-term discomfort.  

Cancer Research UK, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons

Patient Recovery

There are some steps you can take to recover from the side effects of lumbar puncture much sooner and some actions to avoid. These include: 

  • Drinking plenty of liquids  
  • Taking painkillers like paracetamol to decrease the intensity of mild headaches. 
  • Lying down in contrast to sitting up  
  • Removing and redressing the plaster the next day  
  • Not driving or working any machinery for at least 24 hours  
  • not playing rough sport or exercising for up to one week  

Outcomes

Lumbar puncture results might take about 38 hours to come. In extreme cases, a lumbar puncture result can come in a few hours. Some values looked out when a CSF is evaluated including: 

  • Appearance  
  • Opening Pressure  
  • WBC count  
  • Glucose levels 
  • Protein levels 

A lumbar puncture result can help diagnose a wide variety of diseases like: 

  • Meningitis – Inflammation of the protective membranes of the spinal cord and brain  
  • Encephalitis – Inflammation of the tissues of the CNS by infection or autoimmune response  
  • Blood cancers 
  • Neurosyphilis – A disease of the covering of the brain, the brain itself, the spinal cord which occurs in individuals already diagnosed with syphilis.  
  • Guillain-Barre syndrome – A neurological disorder where the immune system attacks parts of the peripheral nervous system or part of the nervous system outside the brain and spinal cord. 

The content shared in the Health Literacy Hub website is provided for informational purposes only and it is not intended to replace advice, diagnosis, or treatment offered by qualified medical professionals in your State or Country. Readers are encouraged to confirm the information provided with other sources, and to seek the advice of a qualified medical practitioner with any question they may have regarding their health. The Health Literacy Hub is not liable for any direct or indirect consequence arising from the application of the material provided.

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