Spinal cord puncture (lumbar or lumbar puncture), as a diagnostic or therapeutic procedure, has been used by doctors for quite a long time. Due to the introduction of new diagnostic methods (CT, MRI, etc.) into medical practice, the frequency of this intervention has noticeably decreased, however, it still remains relevant.

Anatomical nuances

In humans, it is located in the bone canal formed by the vertebrae. At the top it directly passes into the medulla oblongata, and at the bottom it ends with a conical-shaped point at the level of the second lumbar vertebra.

The spinal cord is covered with three outer membranes: hard, arachnoid (arachnoid) and soft. Between the arachnoid and soft membranes is the so-called subarachnoid space, which is filled with cerebrospinal fluid (CSF). The average volume of cerebrospinal fluid in an adult is 120–270 ml and continuously communicates with the fluid of the subarachnoid space of the brain and cerebral ventricles. The spinal membranes end at the level of the first sacral vertebrae, that is, much lower than the location of the spinal cord itself.

Strictly speaking, the term “spinal cord puncture” is not entirely correct, since during this manipulation a puncture of the subarachnoid space is performed at a level where there are no spinal structures.

Characteristics of cerebrospinal fluid

Liquor is normally absolutely transparent and colorless. The pressure can practically be assessed by the rate of flow of liquor from the lumen of the needle: the norm corresponds to approximately 1 drop per 1 second.

If cerebrospinal fluid is taken for further laboratory analysis, the following indicators are determined:

If an infectious lesion of the membranes of the spinal cord and/or brain is suspected, bacterioscopic and bacteriological examination of the cerebrospinal fluid is also performed in order to identify the pathogen.

Methodology

Spinal cord puncture should be performed exclusively in a hospital setting by a specialist who is thoroughly familiar with this technique.

The manipulation is performed with the patient sitting or lying down. The most preferable position is lying on your side with your knees pressed firmly to your chest, your head bowed as far as possible and your back bent. In this position, the intervertebral spaces increase, as a result of which the risk of unpleasant consequences during manipulation is reduced. It is important to remain still throughout the procedure.

Spinal puncture is performed at the level between the third and fourth lumbar vertebrae. In children, a lumbar puncture is performed between the fourth and fifth lumbar vertebrae (taking into account the age-related anatomical features of the spinal structures and spine).

The sequence of actions of the doctor:

1. The skin is treated with any antiseptic solution (for example, iodine and alcohol).
2. Local anesthesia (for example, novocaine solution) is performed at the puncture site.
3. The puncture is performed at a certain angle between the spinous processes of the lumbar vertebrae. For this purpose, a special needle with a translucent mandrel is used.
4. The appearance of cerebrospinal fluid indicates a correctly performed procedure.
5. Further actions are determined by the purpose of the manipulation: cerebrospinal fluid is taken for analysis (in a volume of approximately 10 ml), medications are administered into the subarachnoid space, etc.
6. The needle is removed and the puncture site is covered with a sterile bandage.

After the procedure is completed, the patient turns over onto his stomach and remains in this position for at least two hours. This is carried out in order to prevent such consequences as post-puncture syndrome associated with the leakage of fluid through a defect in the hard shell.

It is important to know that, despite the pain relief provided, the moment of puncture may be accompanied by unpleasant sensations.

Why is a lumbar puncture performed?

Spinal cord puncture is performed for various purposes. The main ones include:

• Collection of cerebrospinal fluid for subsequent analysis.
• Assessment of cerebrospinal fluid pressure, study of the patency of the subarachnoid space using special compression tests.
• Introduction of drugs into the spinal canal, for example, antibiotics or cytostatics.
• Removal of excess cerebrospinal fluid in certain diseases.

Most often, spinal cord puncture is used for diagnostic purposes. In what cases is it used:

• Subarachnoid bleeding in the area of ​​the brain and spinal cord (eg, or trauma).
• Some infectious diseases are meningitis, encephalitis, ventriculitis, neurosyphilis and others.
• Malignant lesion of the membranes of the spinal cord and/or brain.
• Suspicion of liquorrhea or the presence of liquor fistulas (using dyes or contrast agents).
• Normotensive.

Also, spinal cord puncture is sometimes done for fever of unknown etiology in early childhood (up to two years), demyelinating processes, paraneoplastic syndrome and some other pathologies.

Contraindications

There are also contraindications for this procedure. These include:

• Conditions in which there is a high risk of axial herniation are severe swelling of the brain structures and intracranial hypertension, occlusive hydrocephalus, some brain tumors, etc.
• Infectious and inflammatory processes in the lumbar region.
• Serious disorders of the coagulation system, use of drugs that affect blood clotting.

In any case, indications and contraindications for such a procedure are established exclusively by a doctor.

Complications

Like any invasive procedure, lumbar puncture has its complications. Their frequency averages up to 0.5%.

The most common consequences of a lumbar puncture include:

• Axial herniation with the development of dislocation (displacement of structures) of the brain. This complication most often develops after a sharp decrease in the pressure of the cerebrospinal fluid, as a result of which the structures of the brain (usually the medulla oblongata and part of the cerebellum) become “wedged” into the foramen magnum.
• Development of infectious complications.
• The occurrence of headaches, which are usually relieved by lying down.
• Radicular syndrome (the occurrence of persistent pain as a result of damage to the spinal roots).
• Meningeal manifestations. They develop especially often when drugs or contrast agents are introduced into the subarachnoid space.
• The formation of an intervertebral hernia as a result of damage to the cartilage tissue of the disc.
• Bleeding and other hemorrhagic complications.

When a spinal puncture is performed by an experienced specialist with an assessment of all indications and contraindications for this procedure, as well as the patient strictly following the instructions of the attending physician, the risk of complications is extremely low.

Spinal puncture is an important stage in the diagnosis of neurological pathologies and infectious diseases, as well as one of the methods of drug administration and anesthesia.

This procedure is often called a lumbar puncture or lumbar puncture.

Thanks to computed tomography and magnetic resonance therapy, the number of punctures performed has decreased significantly.

However, they cannot completely replace the capabilities of this procedure.

Spinal tap

About the puncture technique

There is a puncture technique that must not be violated and is a gross mistake by the surgeon. Correctly, such an event should be called a puncture of the subarachnoid space, or more simply, a spinal puncture.

The cerebrospinal fluid is located under the meninges, in the ventricular system. This way the nerve fibers are nourished and the brain is protected.

When a disorder occurs as a result of a disease, the cerebrospinal fluid can increase, causing increased pressure in the skull. If an infectious process occurs, the cellular composition undergoes changes and in the case of hemorrhages, blood appears.

The lumbar region is pierced not only for medicinal purposes to administer medication, but also to diagnose or confirm the suspected diagnosis. It is also a popular method of anesthesia for surgery on the peritoneal and pelvic organs.

It is imperative to study the indications and contraindications when deciding on a spinal cord puncture. This clear list must not be ignored, otherwise patient safety will be compromised. Of course, such an intervention is not prescribed by a doctor without a reason.

Who can undergo puncture?

Indications for such manipulation are as follows:

• suspected infection of the brain and its membranes - these are diseases such as syphilis, meningitis, encephalitis and others;
• diagnostic measures for the formation of hemorrhages and the appearance of formations. Used for informational impotence of CT and MRI;
• the task is to determine liquor pressure;
• coma and other disorders of consciousness;
• when it is necessary to administer a drug in the form of cytostatics and antibiotics directly under the membranes of the brain;
• X-ray with the introduction of a contrast agent;
• the need to reduce intracranial pressure and remove excess fluid;
• processes in the form of multiple sclerosis, polyneuroradiculoneuritis, systemic lupus erythematosus;
• unreasonable increase in body temperature;
• spinal anesthesia.

Absolute indications are tumors, neuroinfections, hemorrhages, hydrocephalus.

Sclerosis, lupus, an incomprehensible increase in temperature are not required to be examined in this way.

The procedure is necessary in case of an infectious lesion, since it is important not only to diagnose the diagnosis, but also to understand what type of treatment is required and to determine the sensitivity of microbes to antibiotics.

Puncture is also used to remove excess fluid in case of high intracranial pressure.

If we talk about therapeutic properties, then in this way it is possible to act directly on the focus of neoplastic growth. This will make it possible to have an active effect on tumor cells without an elephant dose of drugs.

That is, cerebrospinal fluid performs many functions - it identifies pathogens, is a carrier of information about cellular composition, blood impurities, identifies tumor cells and tells about the pressure of the cerebrospinal fluid.

Important! Before performing a puncture, it is imperative to exclude possible pathologies, contraindications and risks. Neglecting this can lead to the death of the patient.

When a spinal tap cannot be performed

Sometimes this diagnostic and treatment procedure can cause more harm and can even be life-threatening.

Main contraindications for which puncture is not performed:

Puncture procedure

How do you prepare for the procedure?

Preparation depends on the indications and nuances when performing a spinal puncture. Any invasive procedure requires diagnostic measures consisting of:

1. blood and urine tests;
2. diagnostics of blood properties, in particular coagulation indicators;

Important! The doctor must be informed about medications taken, allergies and pathologies.

Be sure to stop taking all anticoagulants and angioplatelet agents a week before the planned puncture, so as not to provoke bleeding. It is also not recommended to use anti-inflammatory drugs.

Before an x-ray with contrast, women should make sure that there is no pregnancy at the time of puncture. Otherwise, the procedure may negatively affect the fetus.

If the puncture is performed on an outpatient basis

Then the patient himself can come for the study. If he is being treated in a hospital, he is brought from the department by medical personnel.

If you come and go on your own, you should think about returning home. After the puncture, dizziness and weakness are possible; it would be good to get help from someone.

You should not consume food or liquid 12 hours before the procedure.

Puncture can be prescribed for children

The indications are similar in adults. However, the majority are infections and suspected malignancies.

The puncture is not performed without parents, especially when the baby is scared. A lot depends on the parents. They are obliged to explain to the child why the procedure is being performed, to report the pain, that it is tolerable, and to reassure the child.

As a rule, a spinal tap does not involve the administration of anesthesia. Local anesthetics are used. This is done to better tolerate the procedure. But, in case of an allergy to novocaine, you can completely refuse pain relief.

During a puncture, when there is a risk of cerebral edema, it makes sense to administer furosemide 30 minutes before inserting the needle.

The process of taking a puncture

The procedure begins with the patient taking the correct position. There are two options:

1. Lying down. The person is placed on a hard table on his right side. In this case, the legs are pulled towards the stomach and clasped with the arms.
2. Sitting, for example, on a chair. It is important to bend your back as much as possible in this position. However, this position is used less frequently.

The puncture is performed in adults above the second lumbar vertebra, usually between 3 and 4. In children - 4 and 5, to minimize damage to spinal tissue.

The technique of performing the procedure is not complicated if the specialist has been trained and, moreover, has experience. Following the rules allows you to avoid dire consequences.

Stages

The puncture procedure consists of several stages:

Preparation

Medical personnel prepare the necessary tools and materials - a sterile needle with a mandrel (a rod for closing the lumen of the needle), a container for cerebrospinal fluid, and sterile gloves.

The patient takes the required position, the medical staff helps to further bend the spine and fix the position of the body.

The injection site is lubricated with iodine solution and then several times with alcohol.

The surgeon finds the right place, the iliac crest, and draws an imaginary perpendicular line to the spine. It is the right places that are recognized as the safest due to the absence of spinal cord substance.

Pain relief stage

They are used to choose from - lidocaine, novocaine, procaine, ultracaine. It is introduced first superficially, then deeper.

Introduction

After anesthesia, a needle is inserted into the intended location with the cut up at an angle of 90 degrees relative to the skin. Then, with a slight tilt towards the head of the person being examined, the needle is inserted very slowly into the depth.

Along the way, the doctor will feel three needle dips:

1. skin puncture;
2. intervertebral ligaments;
3. membrane of the spinal cord.

After passing through all the gaps, the needle has reached the intrathecal space, which means the mandrel should be removed.

If no cerebrospinal fluid appears, then the needle should penetrate further, but this must be done with extreme caution due to the proximity of the vessels and to avoid bleeding.

When the needle is in the spinal cord canal, a special device - a manometer - determines the cerebrospinal fluid pressure. An experienced doctor can determine the indicator visually - up to 60 drops per minute is considered normal.

The puncture is taken in 2 containers - one sterile in an amount of 2 ml, necessary for bacteriological research, and the second - for cerebrospinal fluid, examined to determine the level of protein, sugar, cellular composition, etc.

Completion

When the material is taken, the needle is removed, and the puncture site is sealed with a sterile napkin and adhesive tape.

The given technique for performing the procedure is mandatory and does not depend on age and indications. The doctor’s accuracy and correctness of actions influence the risk of complications.

In general, the amount of liquid obtained during puncture is no more than 120 ml. If the purpose of the procedure is diagnostics, then 3 ml is sufficient.

If the patient has a particular sensitivity to pain, it is recommended to use sedatives in addition to pain relief.

Important! Throughout the entire procedure, the patient is not allowed to move, so assistance from medical staff is required. If the puncture is performed on children, a parent helps.

Some patients are afraid of puncture because of the pain. But, in reality, the puncture itself is tolerable and not scary. Pain appears as the needle passes through the skin. However, when the tissues are soaked in an anesthetic drug, the pain subsides and the area becomes numb.

When the needle touches a nerve root, the pain is sharp, as with radiculitis. But this happens rarely and even relates more to complications.

When the cerebrospinal fluid is removed, a patient diagnosed with intracranial hypertension experiences a clear feeling of relief and relief from headaches.

Recovery period

As soon as the needle is removed, the patient does not stand up, but remains in a supine position for at least 2 hours on his stomach without a pillow. Children under 1 year of age, on the contrary, are placed on their backs, but pillows are placed under the buttocks and legs.

The first hours after the procedure, the doctor observes the patient every 15 minutes to monitor the condition, because the cerebrospinal fluid can run out of the hole from the needle for up to 6 hours.

As soon as signs of swelling and dislocation of the brain parts appear, help is provided immediately

After the puncture procedure, you must remain in bed. You can get up after 2 days if your readings are normal. If unusual changes occur, the period may increase to 14 days.

Headaches may occur due to decreased fluid volume and decreased blood pressure. In this case, analgesics are prescribed.

Complications

A spinal tap always carries risks. They increase if the algorithm of actions is violated, there is not enough information about the patient, or in case of a serious health condition.

Possible but rare complications are:

If the procedure is carried out in compliance with all conditions, then almost no unwanted consequences appear.

Stage of studying cerebrospinal fluid

Cytological analysis is performed immediately on the same day as the lumbar puncture. When bacteriological culture and antibiotic sensitivity assessment are necessary, the process is delayed for 1 week. This is the time for cells to multiply and evaluate response to medications.

The material is collected in 3 test tubes - for general analysis, biochemical and microbiological.

Normal color Cerebrospinal fluid is clear and colorless, without red blood cells. Protein is contained and should not exceed 330 mg per liter.

There is sugar in small quantities and red blood cells - in adults no more than 10 cells per μl, in children a higher figure is allowed. The normal density of cerebrospinal fluid is 1.005 to 1.008, pH from 7.35-7.8.

If blood is observed in the obtained material, this means that either the vessel is injured, or a hemorrhage has occurred under the membranes of the brain. To clarify the cause, 3 test tubes are collected and examined. If the cause is hemorrhage, the blood will be scarlet in color.

An important indicator is the density of cerebrospinal fluid, which changes during diseases. If there is inflammation, then it increases, if hydrocephalus, it decreases. If the pH level drops, then most likely the diagnosis is meningitis or encephalitis; if it increases, the diagnosis is brain damage from syphilis or epilepsy.

Dark liquid speaks of jaundice or melanoma metastasis.

Turbid cerebrospinal fluid is a bad sign, indicating leukocytosis of bacterial origin.

If protein is increased, then most likely we will talk about inflammation, tumors, hydrocephalus, and brain infection.

Puncture of cerebrospinal fluid was described by Quincke about 100 years ago. Analysis of cerebrospinal fluid, which is obtained from the results of research, allows you to correctly identify diseases, establish an accurate diagnosis and prescribe effective treatment.

This method provides irreplaceable information in the diagnosis of nervous system disorders, the presence of infections and many systemic diseases.

A lumbar puncture is a procedure in which cerebrospinal fluid is removed using a special needle.

The liquid (CSF) is used to test for glucose, certain cells, proteins and other components.

It is often examined to identify possible infections.

A spinal tap is part of most diagnostic tests for spinal diseases.

Indications

For meningitis

Meningitis is an inflammatory process in the brain (often the spinal lining) of the meninges. According to the nature of the etiology, meningitis can have a viral, fungal, or bacterial form.

Meningeal syndrome is often preceded by infectious diseases, and in order to accurately establish the nature and causes of meningitis, the patient is prescribed a lumbar puncture.

During this procedure, the cerebrospinal fluid of the brain is examined.

Based on the results of the examination, intracranial pressure, the volume of neutrophil cells, and the presence of bacteria (Haemophilus influenzae, meningococcus, pneumococcus) are determined.

Lumbar puncture is indicated at the slightest suspicion of purulent meningitis.

For stroke

Stroke is an acute disorder of the blood circulation in the brain.

A lumbar puncture is prescribed to differentiate a stroke and identify the nature of its occurrence.

To do this, the cerebrospinal fluid is placed in 3 different tubes and the blood impurity in each of the tubes is compared.

For multiple sclerosis

Multiple sclerosis is a disease of the nervous system that affects the brain as well as the spinal cord. The main cause of the disease is considered to be dysfunction of the immune system.

The disease occurs when the myelin substance that covers the nerve fibers is destroyed and sclerosis (a type of connective tissue) forms.

Figure: multiple sclerosis

Multiple sclerosis is difficult to diagnose. Therefore, to conduct an accurate study, the patient is prescribed a study using a lumbar puncture.

During this procedure, the cerebrospinal fluid is examined for the presence of antibodies (increased immunoglobulin index).

If the test result is positive, doctors talk about the presence of an abnormal immune response, that is, multiple sclerosis.

For tuberculosis

If tuberculosis is suspected, it is mandatory.

It is carried out to study the cerebrospinal fluid and determine the volume of sugar, neutrophils, and lymphocytes in it.

If the amount of these substances in the cerebrospinal fluid changes, the patient is diagnosed with tuberculosis and the degree of the disease is established.

For syphilis

Indicated for congenital and tertiary forms of syphilis, in case of suspected syphilitic damage to the nervous system (central).

The purpose of the procedure is to identify the symptoms of the disease, as well as the disease itself (syphilis) in its asymptomatic manifestations.

For hydrocephalus

Hydrocephalus is an excess of cerebrospinal fluid in the ventricular system of the brain or in the subarachnoid region.

The increased pressure created by the cerebrospinal fluid on the brain tissue can provoke disorders of the central nervous system.

Based on the results of a lumbar puncture, the pressure of cerebrospinal fluid in the brain tissue is diagnosed.

When it is removed in a volume of 50-60 ml, the condition of patients in 90% of cases improves for some time.

For subarachnoid hemorrhage

A subarachnoid hemorrhage is sudden bleeding into the subarachnoid area.

Fig.: cerebral hemorrhage

It is accompanied by sudden headaches and periodic disturbances of consciousness.

Lumbar puncture is considered the most reliable, accurate and accessible method for diagnosing subarachnoid hemorrhage. Its purpose is to examine the cerebrospinal fluid for the intensity of blood saturation.

If the test results are positive, the patient is diagnosed with subarachnoid hemorrhage.

For the flu

Prescribed for influenza in order to establish the factors and signs of a cold and identify possible infections.

Mild meningeal syndromes often occur against the background of influenza, so in this case, lumbar puncture is considered the most effective diagnostic test.

For other diseases

Lumbar puncture is prescribed:

• if various forms of neuroinfection are suspected;
• in the presence of oncological disorders in the brain;
• for the purpose of diagnosing hemoblastoses for the appearance of blood blast cells, increasing protein levels;
• for diagnostic testing of normal pressure hydrocephalus;
• for the purpose of studying liquorodynamic disorders.

During pregnancy

This procedure is considered dangerous for the expectant mother and the fetus:

• it can cause premature birth or miscarriage:
• Upon completion of the puncture, a pregnant woman may develop reactions leading to disturbances in the functioning of the heart, and in some cases, to brain hypoxia.

In newborns and children

Children are prescribed for:

• suspected meningitis to determine what infection (viral, bacterial) caused the disease;
• the need to determine the volume of protein and red blood cells - insufficient levels can cause infectious diseases of varying complexity.

Fig.: location of lumbar puncture in children

Contraindications for the procedure

Lumbar puncture is contraindicated if:

• intracranial hematoma;
• post-traumatic brain abscess;
• infringement of the brain stem;
• traumatic shock;
• heavy blood loss;
• cerebral edema;
• intracranial hypertension;
• volumetric formation of the brain;
• existing infectious (purulent) processes in the lumbar region;
• the presence of extensive damage to soft spinal tissues;
• bedsores of the lumbosacral area;
• axial dislocation of the brain;
• occlusive form of hydrocephalus
• diathesis of hemorrhagic form;
• pathologies of the spinal (cerebral) canals, accompanied by impaired cerebrospinal fluid circulation;
• subcutaneous infections and their presence in the epidural space;
• brain injuries.

Possible complications (consequences)

Complications based on the results of lumbar puncture appear when the procedure is performed incorrectly.

Violations of diagnostic technology can cause many undesirable consequences:

• Postpuncture syndrome. This pathology occurs when epithelial cells are transferred to the membranes of the spinal cord, which leads to dilation and displacement of intracranial vessels.
• Hemorrhagic complications. These include intracranial hematoma (chronic or acute form), intracerebral hematoma, and its spinal subarachnoid form. Improper procedure can damage blood vessels and cause bleeding.
• Teratogenic factor. This includes epidermoid tumors that form in the spinal canals, which can appear as a result of displacement of skin elements into the area of ​​the spinal canal. Tumors are accompanied by aching pain in the lower legs and lumbar region; painful attacks can progress over the years. The reason is an incorrectly inserted stylet or its absence in the needle itself.
• Direct injury. Improper implementation of the procedure can provoke in the patient various damage to the roots (nerves), infectious complications, various forms of meningitis, and damage to the intervertebral discs.
• Liquorodynamic complications. If a tumor of the spinal canal develops, then changes in cerebrospinal fluid pressure during the procedure can provoke acute pain or an increase in neurological deficit.
• Changes in liquor composition. If foreign bodies (air, various anesthetics, chemotherapy drugs and other substances) are introduced into the subarachnoid area, they can provoke a weak or increased meningeal reaction.
• Other complications. Minor and quickly disappearing complications include nausea, vomiting, and dizziness. Improper lumbar puncture causes myelitis, radiculitis, and arachnoid.

Algorithm

Lumbar puncture is performed by a qualified doctor with the presence of a nurse.

Nurse:

• prepares a kit for a spinal puncture (it consists of sterile cotton wool, a 3 percent iodine solution, a 0.5 percent novocaine solution, a special needle, alcohol, sterile gloves, test tubes);
• prepares the patient for the procedure;
• assists the doctor in the process of performing manipulations;
• Provides necessary care to the patient after the procedure.

Photo: needles for puncture of cerebrospinal fluid

To properly perform a lumbar puncture, you must:

• place the patient in a certain sitting position;
• determine the puncture site and treat the nearby area with an alcohol solution;
• administer skin anesthesia;
• perform a spinal tap;
• remove the mandrin and place it in a sterile test tube;
• collect a specified amount of cerebrospinal fluid for research;
• it is necessary to insert a mandrin into the needle, and then carefully remove the needle;
• treat the puncture site;
• apply a bandage.

Patient preparation

Before performing a lumbar puncture, the patient must notify the attending physician:

• about the use of any medications;
• presence of allergic reactions;
• presence (absence) of pregnancy;
• about possible blood clotting disorders.

The patient is prepared in compliance with certain conditions:

• Before starting the procedure, the patient's bladder must be completely empty.
• When a lumbar puncture is part of an x-ray examination, the patient needs to clear the intestines to eliminate the accumulation of gases (intestinal contents) while imaging the spine.
• The patient is transported to the ward room on a gurney in a horizontal position (on his stomach).
• In the room, the patient is placed in a sitting position and bent forward or placed in a “side-lying” position, in which the knees are bent towards the stomach. Next, skin anesthesia is performed and the operation itself is carried out.

Technique

As a rule, a spinal puncture is performed in a hospital setting as follows:

• The puncture area is determined. It is located between the 3-4 or 4-5 lumbar vertebrae.
• The nearby area is treated with 3 percent iodine and 70 percent ethyl alcohol (from the center to the periphery).
• An anesthetic solution is injected (5-6 ml is enough). Novocaine is most often used as anesthesia.
• Between the spinous processes, adhering to the midline, a “Bira” needle is inserted with a slight slope.
• The needle should enter the subarachnoid area (the needle can be felt at a depth of 5-6 cm).
• When the mander is removed, the cerebrospinal fluid should flow out. This confirms that the procedure was carried out correctly. For an accurate analysis, it is necessary to collect about 120 ml of cerebrospinal fluid.
• After collecting the cerebrospinal fluid, it is necessary to measure the patient's pressure.
• The injection site is treated with an antiseptic solution.
• A sterile dressing is applied.

The duration of the procedure is about half an hour.

What sensations does the patient experience during a lumbar puncture?

If the procedure is carried out correctly, the patient should not feel any discomfort, discomfort or pain.

Sometimes the patient may feel:

• patency of the needle, which is not accompanied by painful symptoms;
• a small injection when injecting an anesthetic solution;
• the effect of a slight electric shock if a spinal puncture needle touches a portion of the spinal nerve.
• pain in the head (about 15% of patients feel them during a lumbar puncture).

Caring for the patient after the procedure

Upon completion of the spinal tap, patients:

• bed rest is prescribed for a day (sometimes bed rest is prescribed for up to 3 days - if certain medications are administered to the subarachnoid area).
• you need to take a horizontal position and lie on your stomach;
• it is necessary to create conditions of rest, provide plenty of drink (not cold);
• administer intravenous plasma expanders (if necessary).

Sometimes after the procedure the patient experiences:

• fever, chills, or tightness in the neck area;
• numbness and discharge from the puncture site.

In such cases, urgent consultation with a doctor is required.

Results

The purpose of a lumbar puncture is to obtain cerebrospinal fluid and its subsequent examination.

Based on the results of a spinal puncture, cerebrospinal fluid is examined, which can be presented in one of four options:

• Blood: indicates the presence of hemorrhagic processes (initial stage of subarachnoid hemorrhage).
• Yellowish color: due to the long-standing processes of a hemorrhagic nature (chronic hematomas, meningeal carcinomatosis, blockade of liquor circulation in the subarachnoid region).
• Grayish green color: often indicates the presence of brain tumors;
• Clear liquor- this is the norm.

Norm and pathology

The cerebrospinal fluid undergoes a complete examination:

• CSF pressure is measured;
• the liquid is assessed macroscopically;
• the volume of protein and sugar is determined;
• cell morphologies are examined.

Norm:

• Cerebrospinal fluid color: clear
• Protein content: 150 – 450 mg/l
• Glucose volume: from 60% in blood
• Atypical cells: no
• Leukocytes: up to 5 mm3
• Neutrophils: no
• Red blood cells: no
• The normal liquor pressure is 150-200 water. Art. or 1.5 – 1.9 kPa.

Deviation from the norm may indicate the presence of liquor hypertension.

If the pressure exceeds the norm (more than 1.9 kPa), this is an indication for decongestant therapy. If the cerebrospinal fluid pressure is low (less than 1.5 kPa), this indicates the presence of brain pathologies (severe swelling, blockage of the cerebrospinal fluid pathways in the spinal canals).

Besides:

• With various pathologies, red blood cells, neutrophils and pus are detected in the blood.
• The presence of atypical cells may indicate a brain tumor.
• A low glucose value is an indicator of bacterial meningitis.

Photo: malignant cells in the cerebrospinal fluid

What can affect the result?

Unfortunately, the result of a lumbar puncture can be affected by:

• restless position of the patient during the procedure;
• obesity;
• dehydration;
• severe arthritis;
• previous spinal surgeries;
• bleeding into the cerebrospinal fluid;
• With proper puncture, it is impossible to collect cerebrospinal fluid.

Lumbar puncture can be invaluable in diagnosing diseases and infections that are dangerous to the body.

When performed correctly, the procedure is absolutely safe.

Video: goals and features of the event

Lumbar puncture is the removal of fluid from the spinal canal in order to clarify the diagnosis and identify associated complications. This is a rather complicated procedure for the human body, but it allows you to identify the presence of common health problems. Such a study is prescribed extremely rarely, only if it is otherwise impossible to make or confirm the diagnosis.

When performing a puncture, the person must be in a completely immobilized state, because any sudden or careless jerk can provoke serious consequences for the life and health of the patient. Preparing for a puncture requires the right psychological attitude. Before the manipulation, it is necessary to take a “working” position on the couch: the patient is placed on his side, his knees should be pressed as close to his stomach as possible, and his head should be pulled towards his chest. This position ensures stretching of the spine, increasing the intervertebral spaces for free penetration of the needle.

Indications for the procedure

Many patients are interested: why do they take a spinal cord puncture? Typically, a doctor gives a referral for testing in the following cases:

• suspicion of infectious processes in the brain or spinal cord

• identification of bone tissue compactions on x-rays

• suspicion or detection of subarachnoid hemorrhage - accumulation of blood between the two membranes of the brain

• the occurrence of tumor processes

Sometimes a puncture is performed for therapeutic purposes - to inject medication directly into the cerebrospinal fluid. This way you can eliminate the consequences or pain symptoms of an intervertebral hernia.

Possible complications

This procedure should be carried out by a professional with experience in such research. Medical students cannot be trusted with the procedure without the supervision of an experienced doctor. These are not empty warnings, because the procedure has a number of possible consequences, which are often impossible to eliminate.

Among the serious consequences are often found

• infection of the cerebrospinal fluid with subsequent spread of the virus throughout the body

• bleeding of varying strength and duration

• increased intracranial pressure

• spinal root injury

Side effects of the procedure include dizziness, nausea, drop in blood pressure, lightheadedness, and back pain. If the discomfort is severe, the doctor prescribes painkillers. The remaining effects of the study will go away on their own within a day. In this case, patients are not recommended to get out of bed earlier than 10-12 hours after the puncture and remain in a supine position. It is also impossible to tear off the bandage before the time specified by the doctor - the risk of wound infection increases.

Myths about spinal tap

Many inexperienced patients believe that during the procedure the doctor will touch the spinal cord with a needle, which will lead to disability of the person being examined. This is a common misconception, because the area for collecting biomaterial for research is much lower than the spinal cord itself.

A spinal puncture is the insertion of a special needle into the subarachnoid space of the spinal cord to remove cerebrospinal fluid for research or for therapeutic purposes. This manipulation has many synonyms: lumbar puncture, lumbar puncture, lumbar puncture, puncture of the subarachnoid space of the spinal cord. In our article we will talk about indications and contraindications for this procedure, the technique of its implementation and possible complications.

Indications for lumbar puncture

As mentioned above, a lumbar puncture can be performed for diagnostic or therapeutic purposes.

As a diagnostic procedure, a puncture is performed if it is necessary to examine the composition of the cerebrospinal fluid, determine the presence of infection in it, measure the cerebrospinal fluid pressure and patency of the subarachnoid space of the spinal cord.

If it is necessary to remove excess cerebrospinal fluid from the spinal canal, introduce antibacterial drugs or chemotherapy into it, a lumbar puncture is also performed, but as a method of treatment.

Indications for this manipulation are divided into absolute (that is, in these conditions, puncture is mandatory) and relative (the doctor decides at his own discretion whether to perform a puncture or not).

Absolute indications for spinal puncture:

• infectious diseases of the central nervous system (, and others);
• malignant neoplasms in the area of ​​the membranes and structures of the brain;
• diagnosis of liquorrhea (leakage of cerebrospinal fluid) by injecting radiopaque substances or dyes into the spinal canal;
• hemorrhage under the arachnoid membrane of the brain.

Relative readings:

• and other demyelinating diseases;
• polyneuropathy of inflammatory nature;
• septic vascular embolism;
• fever of unknown origin in young children (up to 2 years);
• systemic lupus erythematosus and some other systemic connective tissue diseases.

Contraindications for lumbar puncture

In some cases, carrying out this therapeutic and diagnostic manipulation can cause more harm to the patient than good, and can even be dangerous for the patient’s life - these are contraindications. The main ones are listed below:

• severe cerebral edema;
• sharply increased intracranial pressure;
• the presence of a space-occupying formation in the brain;

These 4 syndromes during a spinal puncture can lead to axial herniation - a life-threatening condition when part of the brain descends into the foramen magnum - the functioning of the vital centers located in it is disrupted, and the patient may die. The likelihood of herniation increases when using a thick needle and removing a large amount of cerebrospinal fluid from the spinal canal.

If puncture is necessary, the minimum possible amount of cerebrospinal fluid should be withdrawn, and if signs of herniation appear, the required amount of fluid from the outside should be urgently injected through the puncture needle.

Other contraindications are:

• pustular rashes in the lumbar region;
• diseases of the blood coagulation system;
• taking blood thinning medications (antiplatelet agents, anticoagulants);
• hemorrhage from a ruptured aneurysm of a vessel in the brain or spinal cord;
• blockade of the subarachnoid space of the spinal cord;
• pregnancy.

These 5 contraindications are relative - in situations where performing a lumbar puncture is vital, it is performed in them as well, simply taking into account the risk of developing certain complications.

Puncture technique

During this manipulation, the patient, as a rule, is in a position lying on his side with his head tilted to his chest and his legs pressed to his stomach, his knees bent. It is in this position that the puncture site becomes as accessible as possible to the doctor. Sometimes the patient is not in a lying position, but sitting on a chair, while he leans forward and puts his hands on the table and his head in his hands. However, this provision has recently been used less and less.