Lumbar puncture is the procedure of inserting a needle into the subarachnoid space of the spinal cord at the lumbar level. It is performed to determine spinal pressure, obtain cerebrospinal fluid to study the composition of the cerebrospinal fluid and for anesthesia. Lumbar puncture in Moscow is performed at the Yusupov Hospital. Neurologists perform spinal taps for both diagnostic and therapeutic purposes. The neurology clinic has all the conditions for treating patients:
- rooms of varying comfort levels are equipped with air conditioning;
- patients are provided with individual personal hygiene products and dietary nutrition;
- Doctors use modern diagnostic equipment from leading companies in the world to examine patients;
- medical staff is attentive to the wishes of patients and their relatives.
The Yusupov Hospital employs candidates and doctors of medical sciences, doctors of the highest category. They are fluent in the technique of performing lumbar puncture. Lumbar puncture is performed for stroke and traumatic brain injury. Lumbar puncture for multiple sclerosis is necessary to obtain cerebrospinal fluid for laboratory testing. The detection of a large number of immunoglobulins (antibodies) in the cerebrospinal fluid, as well as oligoclonal bands (a special arrangement of immunoglobulins during a more specific test) or the determination of proteins - products of myelin breakdown, gives doctors reason to assume a diagnosis of multiple sclerosis. The lumbar puncture protocol is recorded in the medical history.
Indications and contraindications for lumbar puncture
The procedure in question may be performed to diagnose or treat certain diseases. If you need to obtain accurate diagnostic data, then a lumbar puncture is prescribed if necessary:
- identify or exclude the presence of an infectious agent in the cerebrospinal fluid (CSF);
- clarify the indicators of liquor pressure;
- identify the patency of the subarachnoid space of the spinal cord.
In the case of therapeutic measures, a puncture may be necessary to introduce antibacterial agents into the cerebrospinal fluid and get rid of excess cerebrospinal fluid. Indications and contraindications for lumbar puncture are divided into mandatory and conditional. As part of diagnosis and treatment, the procedure is indicated for:
- any infectious diseases of the central nervous system;
- suspected leakage of cerebrospinal fluid;
- malignant tumors localized directly in the structures of the spinal cord;
- hemorrhage into the arachnoid membrane.
Lumbar puncture is also allowed for multiple sclerosis, vascular embolism, systemic diseases, and fever in early childhood. In case of these problems, the appropriateness of the procedure in question is determined by the attending physician.
Cerebrospinal fluid puncture is often performed in premature infants, and this procedure can be decisive in making a diagnosis. Such “complex” newborns may have hydrocephalus without pronounced symptoms, and the diagnostic results from the cerebrospinal fluid will provide answers to doctors’ questions regarding the correct diagnosis.
Contraindications to the procedure in question for diagnostic or therapeutic purposes are:
- cerebral edema, severe and with severe symptoms;
- high intracranial pressure of clarified or unknown etiology;
- diagnosed brain tumors;
- occlusive hydrocephalus;
- problems in the blood coagulation system;
- pregnancy;
- long-term use of anticoagulants.
In some situations, when accurate diagnosis is required, a spinal puncture can be performed despite existing contraindications. For example, the results of a lumbar puncture analysis for meningitis make it possible to determine the type of infectious agent and select effective medications. And if a pathology is diagnosed or suspected in a pregnant woman, then doctors neglect this situation and do everything to save the patient’s life.
Research results
As a rule, CSF is collected in 3 containers, which are then sent for general, biochemical and microbiological analysis.
Doctors pay attention to the color of the cerebrospinal fluid:
- Bloody - an admixture of blood in the fluid may indicate blood leaking into the cavity between the arachnoid and pia mater.
- The yellowish color of the CSF indicates long-term development of hemorrhagic processes, for example, subdural hematoma (accumulation of blood between the brain and membranes), metastases in the meninges, blockage of the cerebrospinal fluid pathways.
- Grayish-green – neoplasms in the brain.
- Transparent – the person is healthy.
The ventricular mass is carefully examined, doctors measure pressure, determine the amount of protein, glucose, etc.
Normal results of a cerebrospinal fluid test look like this:
- liquid color – transparent;
- protein level – from 150 to 450 mg/l;
- glucose concentration – from 4 to 60% of the blood level;
- there are no atypical cells;
- leukocytes – up to 5 in 1 mm³ of blood;
- neutrophils and red blood cells are absent;
- pressure – from 150 to 200 mm Hg. Art.
Important. If the cerebrospinal fluid pressure is higher than normal, then decongestant therapy should be performed. If this indicator is underestimated, then this indicates brain pathologies.
Red blood cells, neutrophils and pus indicate blood diseases. Atypical cells are found in brain tumors, and sugar levels decrease in bacterial meningitis.
Lumbar puncture will allow timely identification of many dangerous diseases and treatment.
How is a lumbar puncture performed?
Since the procedure in question is quite complex, it is carried out by an experienced doctor and only after preliminary preparation of the patient. Algorithm for preparing for a spinal puncture:
- the skin in the area of the future puncture and insertion of a special needle is treated with medical alcohol and lubricated with iodine;
- then novocaine or lidocaine (painkillers) is injected subcutaneously;
- immediately after the formation of the so-called lemon peel, the administration of these drugs continues intradermally and further into the future puncture.
Many patients wonder whether it hurts to do a spinal tap. Unpleasant (but not painful) sensations are possible only during the period of preparation for the procedure, when the doctor administers painkillers.
After preparation, the procedure itself begins:
- The puncture is made between the spinous processes between the 3rd and 4th vertebrae (in childhood patients - between 4th and 5th). Some patients are terrified of a lumbar puncture because they believe that there is a possibility of spinal cord damage. But the puncture is made where there is simply none! The spinal cord ends between vertebrae 1 and 2, so there is no such threat to health.
- The doctor inserts a special needle with a device that closes its lumen (mandrin) at a slight angle. As soon as the needle enters the subarachnoid space, the specialist feels a certain “failure”. After this, you can remove the mandrin - cerebrospinal fluid will begin to come out of the needle.
- If cerebrospinal fluid does not drain, the patient may be asked to elevate their upper body to increase pressure. If the procedure in question was performed frequently, then the doctor may try to collect cerebrospinal fluid for examination a little higher than the specified location - adhesions may prevent a quick and successful puncture.
- If it is necessary to measure the pressure of the cerebrospinal fluid, a special tube is attached to the needle. But an experienced doctor will make such measurements without additional instruments - the output of cerebrospinal fluid at a rate of 60 drops per minute will indicate the norm. But it must be taken into account that the rate of spinal puncture in newborns when measuring pressure will be slightly higher.
Before the procedure
Tell your healthcare provider if:
- you are allergic to iodine (which is a component of Betadine®);
- you are sensitive to or allergic to any adhesive materials, such as adhesives;
- you are taking blood thinning medications. These medications include heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), and tinzaparin (Innohep®). There are others, so be sure to tell your doctor about all the medications you take.
to come back to the beginning
Complications and consequences of lumbar puncture
In the first 2-3 hours after the procedure, the patient should be in a horizontal position; some discomfort is possible - for example, a headache after a lumbar puncture, which quickly disappears and does not require the use of painkillers. You should not lift weights or walk a lot in the first 3-4 days.
Possible complications and consequences of lumbar puncture:
- irritation of the meninges;
- persistent pain in the puncture area;
- disc damage and hernia formation;
- bleeding;
- infection of the central nervous system.
More detailed information about the rules of the procedure and the cost of a needle for lumbar puncture can be obtained on the pages of our website Dobrobut.com.
Reviews
Almost all patients respond positively to lumbar puncture. The procedure does not cause significant discomfort or pain, but provokes mental stress. In most cases, there are no complications after a lumbar puncture, although it all depends on the skill level of the doctor.
Irina, 45 years old: “I was treated several times in an inpatient setting for meningitis, and then a lumbar puncture was prescribed. It was scary the first time, but then I realized that there was nothing wrong with it. I felt a slight pain only during the anesthetic injection, then there was a sensation of interference in the lower back, but it became numb. The main thing is to find an experienced doctor, because you can remain disabled if you catch a nerve.”
Ekaterina, 34 years old: “I had a lumbar puncture twice for suspected meningitis. There were no serious complications after the procedure, although after the first time I had a headache. The second time I asked the doctor to make a puncture with a smaller needle, then I didn’t feel anything at all, and there was no headache.”
Igor, 44 years old: “I had to do a spinal tap 3 times. During the procedure, pain is not felt, only movement in the lumbar region was heard, this causes psychological discomfort. I tried to distract myself and stopped paying attention to it. There were never any complications after the study.”
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Good afternoon, my age is 58 years old. Like the others, diseases of the cervical and lumbar spine. I underwent a course of treatment at the clinic with Dr. Sorokin. The feeling is unforgettable! In both sections (in the neck and in the lower back) there was a protrusion, and just below there was a hernia. It helped almost immediately: after 2 sessions. Now... Read more
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I am immensely grateful to Evgeniy Yuryevich Zolotarev for his help in treating my mother. With his help, she recovered perfectly. The improvement is obvious. I started walking, the pain gradually went away, my leg did not swell much. Many thanks to such wonderful doctors as Evgeniy Yurievich! I wish your clinic, everyone... Read more
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