LUMBAR PUNCTURE

(Cerebrospinal Fluid Analysis; Cerebrospinal Fluid Tap; Puncture, Lumbar; Spinal

Tap)

Definition

This is a procedure to collect cerebrospinal fluid (CSF). It involves inserting a needle

between the third and fourth lumbar vertebrae in the back and extracting a sample of
fluid.

Lumbar Puncture Method

Parts of the Body Involved

Done between the third and fourth lumbar vertebrae

Reasons for Procedure

A lumbar puncture is done when the following conditions are suspected:

• Meningitis (inflammation of the membranes that cover the brain and spinal cord)

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 • Encephalitis (inflammation of the brain)
• Guillain-Barré syndrome (inflammation of the nerves outside the brain and spinal
cord)
• Multiple sclerosis (disease caused by inflammation, destruction, and scarring of
the sheath that covers nerve fibers in the brain and spinal cord)
• Any disorder affecting the nervous system
• Central nervous system syphilis
• Lymphoma, leukemia, or other cancers involving the brain or central nervous
system
• Certain forms of hydrocephalus (water on the brain)
• Bleeding in the brain or spinal cord

The procedure may also be done to:

• Administer dye for imaging studies

• Drain spinal fluid to lower pressure within the brain
• Administer medications (e.g., chemotherapy, anesthesia)
Risk Factors for Complications during the Procedure
• A local infection at the site where the needle would be inserted
• Elevated pressure in the skull
What to Expect

Prior to Procedure

• CT scan —a type of x-ray that uses a computer to make pictures of structures

inside the body (This test may be done.)
• Your back will be cleaned at the site where the needle will be inserted.

Anesthesia

• Local anesthesia

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Description of the Procedure

• You lie on your side with knees drawn up to abdomen. A needle is inserted into
the spinal canal through your lower back. A sample of CSF is withdrawn through
the needle. The pressure of the CSF is measured. If you experience discomfort,
the needle may need to be repositioned. If you have a problem with your lower
back and cannot lie on your side, the CSF may be taken from the top of the spine.

After Procedure

• The fluid is sent to a lab for analysis. You lie down for 10-15 minutes. Unless you
have a severe headache, you can leave.

How Long Will It Take?

• 30 minutes or more

Will It Hurt?

• Overall, discomfort is minimal to moderate. The anesthetic will sting when first
injected. There is usually a little pain when the needle is first inserted, but it
should subside in a few seconds.

Possible Complications

• Local bleeding
• Headache
• Backache
• Allergic reaction to the anesthetic

These complications are rare:

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 • Herniation and death
• Local infection
• Pain or abnormal burning, pricking, or tingling sensations in your legs
• Hematomas (blood clots)
• Inflammation of the arachnoids mater (a delicate membrane lining the nervous
system)
• Temporary paralysis of a cranial nerve
• Rupture of the soft, central portion of the intervertebral disk (called the nucleus
pulposus)
• Tumor (called intraspinal epidermoid tumor)
• Meningitis

Average Hospital Stay

• This is typically an outpatient procedure. It does not require a hospital stay.

Postoperative Care

When at home, follow your doctor's instructions, such as:

• Drink extra fluids for the next 24 hours.

• Rest and remain quiet for at least 24 hours.
Outcome

Based on the pressure and contents of the CSF, a diagnosis can often be made. High
pressure can indicate swelling, bleeding, a tumor, or hydrocephalus.

The CSF is also analyzed for:

• Antibodies
• Bacteria, viruses, fungi
• Cancer cells

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 • Excess protein
• White blood cells

Normal CSF is clear and contains no blood. If there is blood or a yellowish color, it may
indicate an obstruction or bleeding in the brain or spinal cord.

Call Your Doctor If Any of the Following Occurs

• Severe headache or headache lasting for more than 24 hours

• Nausea or vomiting
• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, bleeding, or discharge from the site of the
spinal tap
• Tingling
• Numbness or pain in your lower back and legs
• Problems with urination

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REFERENCES:

• http://www.aafp.org/

• http://www.nlm.nih.gov/

• http://www.aboutkidshealth.ca/

• http://www.hc-sc.gc.ca/index_e.html