A lumbar spinal tap is a diagnostic procedure in which a needle is inserted into the lumbar region to obtain a sample of cerebrospinal fluid. Also, spinal puncture (or, as it is also called, spinal puncture) can be performed for anesthetic or therapeutic purposes. The procedure will be discussed in more detail in this article.
Spinal puncture
Indications for use
A spinal puncture is prescribed in the following cases:
- conducting a diagnostic examination of spinal cord fluid;
Spinal cord membranes - measuring cerebrospinal fluid pressure;
- study of the spinal cord liquor pathways using a contrast agent (myelography);
- injection of a drug into the intervertebral region;
- introduction of radioactive compounds or special pigment solutions in order to increase the clarity of the fluid jet display.
Lumbar puncture
Based on the results of the tests, the doctor will be able to detect pathogenic microorganisms of viral and fungal origin, including encephalitis, meningitis and syphilis. Spinal puncture can also detect certain types of cancers affecting the patient's brain or spinal cord , intracerebral hemorrhage, or inflammation of the central nervous system.
Lumbar puncture is performed to collect cerebrospinal fluid
If you want to learn in more detail how to correctly identify spinal cancer, as well as consider the symptoms and manifestations of the disease, you can read an article about this on our portal.
Diagnosis of diseases
Based on the results of a spinal tap, various pathologies can be diagnosed, ranging from multiple sclerosis or meningitis to cancer affecting the spinal cord. Below are the most commonly diagnosed pathologies.
Spinal puncture allows you to diagnose a number of diseases
Table. Diseases that can be detected by spinal puncture.
| Disease | Short description |
| Meningitis | A common infectious disease that affects the membranes of the brain or spinal cord. In rare cases, the inflammatory process can immediately spread to both the spinal cord and the patient’s brain, which significantly complicates the treatment process. |
| Neurosyphilis | A disease of the nervous system, which is accompanied by the development of an infectious process. During the development of the disease, the causative agent of syphilis penetrates the nervous tissue, resulting in unpleasant symptoms. |
| Guillain-Barre syndrome | Acute polyradiculoneuropathy, which is inflammatory in nature. The main symptom of GBS is the development of protein-cell dissociation or peripheral paralysis. The patient may also experience autonomic disorders, decreased sensitivity and flaccid paresis. |
| Abscess (boil) | Accumulation of purulent mass against the background of the development of local chronic infection. As a result, tissue structure is destroyed at the site of inflammation. An abscess occurs when various microbes enter the body. Typically this occurs through wounds, punctures or abrasions on the body. |
| Multiple sclerosis | A common, chronic autoimmune disease that affects the spinal cord and brain. As the pathology develops, the patient’s nervous tissue is destroyed, and scar tissue forms in its place. |
| Spinal cord cancer | A very dangerous oncological disease, which is accompanied by a compression effect, which negatively affects the patient’s spinal cord. |
Spinal puncture technique and cerebrospinal fluid composition
Note! In addition to diagnosing various pathologies, spinal puncture is often performed with the aim of introducing an anesthetic drug into the patient’s body. Typically, this procedure is required during chemotherapy.
Indications and contraindications for lumbar puncture
Aplastic anemia
Aplastic anemia is a severe blood disease in which suppression of all bone marrow sprouts develops. The causes of the disease are various - from genetic predisposition to the harmful effects of ionizing radiation and various chemical compounds. Clinically, the disease manifests itself as anemic, thrombocytopenic syndrome, as well as severe infectious complications. The diagnosis is made based on the clinical picture, blood tests and bone marrow puncture.
What is aplastic anemia?
Aplastic anemia is a pathological condition of the body in which the number of all three types of blood cells (erythrocytes, leukocytes and platelets) decreases due to a slowdown or complete cessation of their formation in the bone marrow. By origin, aplastic anemia is divided into:
- congenital;
- acquired.
In most cases, inhibition of all three germs of hematopoiesis is observed, however, it has been clinically observed that in different phases of the disease a more pronounced inhibition of one of the germs may be observed
Based on the predominant damage to bone marrow sprouts, the following are distinguished:
- inhibition of one hematopoietic lineage (erythrocyte, leukocyte or platelet);
- inhibition of two hematopoietic germs;
- inhibition of three hematopoietic germs.
Causes of aplastic anemia
The causes of aplastic anemia differ between congenital and acquired anemia.
The following causes of acquired aplastic anemia are distinguished:
- ionizing radiation;
- medications (decaris, analgin, chloramphenicol, tetracycline, butadione, etc.);
- chemical compounds (pesticides, benzene);
- diseases (viral hepatitis A, B and C, Epstein-Barr virus, cytomegalovirus, herpes virus, HIV, parvovirus B19, etc.).
- hormonal disorders of the ovaries, thyroid gland and thymus gland.
Some harmful agents directly affect the bone marrow (ionizing radiation, chemicals and drugs). Others act indirectly through autoimmune mechanisms (viral hepatitis B).
Diagnosis of aplastic anemia
The clinical picture of the disease can largely guide the doctor in the direction of anemia, but the diagnosis must be confirmed or refuted using laboratory tests and paraclinical studies. The most valuable additional studies are:
- complete blood count (CBC);
- biochemical blood test (BAC);
- sternal puncture;
- trepanobiopsy.
General blood analysis
Data from a general blood test for aplastic anemia indicate pancytopenia (a decrease in the number of all three types of bone marrow cells). A decrease in the number of leukocytes is observed mainly due to a decrease in granulocytes (neutrophils, eosinophils and basophils). Thus, the percentage of lymphocytes and monocytes in the leukocyte formula increases relatively. At various stages of the disease, inflammatory signs to one degree or another can be detected. Indicative indicators of UAC for aplastic anemia are:
Hemoglobin (Hb) – less than 110 g/l (normal 120 – 160 g/l). Reduction due to a decrease in the number of red blood cells.
Red blood cells – 0.7 – 2.5 x 1012\l (normal 3.7 x 1012\l). Decrease in the number of mature red blood cells.
Reticulocytes - less than 0.2% (normal 0.3 - 2.0%). Decrease in the number of young forms of red blood cells.
The color index is 0.85 – 1.05 (the norm is 0.85 – 1.05) indicates the normochromic nature of anemia (the hemoglobin content in the erythrocyte is within the normal range).
Hematocrit (Ht) – less than 30 (normal 35 – 42 in women and 40 – 46 in men). The ratio of the cellular composition of blood to its liquid part. There is a clear decrease in the proportion of cells in the peripheral blood.
Platelets – less than 35 ppm or 100 x 109\l. Decreased platelet count.
Leukocytes – 0.5 – 2.5 x 109\l (normal 4 – 9 x 109\l). Severe leukopenia due to a decrease in the number of granulocytes (neutrophils, eosinophils and basophils).
Band neutrophils – 0 – 2% (normal is less than 6%). Decreased production of young forms of leukocytes.
Segmented neutrophils – 0 – 40% (normal 47 – 72%). Decrease in the number of mature forms of neutrophils.
Myelocytes – 0 – 2% (normally absent). In conditions of granulocytopenia and bacterial infection, a more pronounced than usual shift in the leukocyte formula to the left is observed with the appearance of leukopoiesis precursor cells.
Eosinophils – 0 – 1% (normal 1 – 5%). Decrease in the number of eosinophils.
Basophils – 0% (normal 0 – 1%). Single or complete absence of basophils.
Lymphocytes - more than 40% (normal 19 - 37%). The number of lymphocytes remains normal. Due to a decrease in the granulocyte fraction, relative lymphocytosis is observed (an increase in the proportion of lymphocytes in the blood). Extremely pronounced lymphocytosis can be observed with the accumulation of viral infections.
Monocytes – more than 8% (normal 6 – 8%). The number of monocytes is unchanged and within normal limits. Monocytosis (increased proportion of monocytes in the blood) is explained by a decrease in the percentage of granulocytes in the leukocyte formula.
The erythrocyte sedimentation rate is more than 15–20 mm/hour (the norm is up to 10 mm/hour in men and up to 15 mm/hour in women). This indicator reflects the severity of the inflammatory response in the body.
Anisocytosis is the presence of red blood cells of various sizes in the blood.
Poikilocytosis is the presence of red blood cells of various shapes in the blood.
Blood chemistry
Some types of biochemical blood tests can focus the doctor’s attention on abnormalities in the body that indirectly fit into the three anemic syndromes listed above. Approximate indicators of BAC for aplastic anemia are:
Serum iron is more than 30 µmol/l (normal 9 – 30 µmol/l). Increased serum iron levels due to frequent blood transfusions. High risk of developing hemochromatosis.
Erythropoietin more than 30 IU/l (normal 8 – 30 IU/l in women and 9 – 28 IU/l in men). The increase in erythropoietin occurs for two reasons. Firstly, it is not consumed by the cells of the erythrocyte lineage. Secondly, its synthesis increases compensatoryly in response to anemia.
C-reactive protein – more than 10 – 15 mg/l (normal 0 – 5 mg/l). It is detected during an inflammatory reaction against a background of weakened immunity.
Thymol test - more than 4 (norm 0 - 4). Detects signs of inflammation in weakened immune systems.
Sternal puncture
This type of study is used to visualize bone marrow cells and their percentage. With aplastic anemia, the myelogram will be scanty, the number of cellular elements is significantly reduced. Cambial cells of the erythrocyte and leukocyte series are single or absent. Megakaryoblasts are absent. In rare cases, during puncture it happens to encounter grouped foci of increased cell proliferation as a compensatory reaction of healthy bone marrow to anemia. Such a myelogram may be misleading because it will indicate the absence of aplastic anemia and will therefore be false negative.
Trephine biopsy
Trephine biopsy is a method of removing part of the bone marrow from the patient's ilium wing. The advantage of this procedure over sternal puncture is the possibility of collecting a larger amount of material while maintaining its structure. A larger amount of material reduces the likelihood of a false negative result of aplastic anemia, and studying the structure of the bone marrow allows, in addition to a cytological examination (myelogram), to also conduct a histological examination. Using a blood test and trepanobiopsy results, it is possible to determine the severity of aplastic anemia.
- Aplastic anemia of moderate severity is determined by the following indicators:
granulocytes less than 2.0 x 109\l;
platelets less than 100 x 109\l;
reticulocytes less than 2 – 3%;
bone marrow hypoplasia on trephine biopsy.
- Severe aplastic anemia is determined by the following indicators:
granulocytes less than 0.5 x 109\l;
platelets less than 20 x 109\l;
reticulocytes less than 1%;
bone marrow aplasia on trephine biopsy.
- Extremely severe aplastic anemia is determined by the following indicators:
granulocytes less than 0.2 x 109\l;
platelets are single or absent;
reticulocytes are single or absent;
bone marrow aplasia on trephine biopsy.
Prognosis for aplastic anemia
The prognosis for aplastic anemia largely depends on the timing of detection of the disease. With early detection, there is the possibility of more active intervention in the course of the disease. If detected later, the chances of cure decrease. Congenital Fanconi aplastic anemia is in most cases extremely difficult to treat, since the bone marrow has never been healthy and, accordingly, is very difficult to recover. The presence of congenital developmental anomalies greatly limits the indications for bone marrow transplantation in such patients. In most cases, patients die in childhood from developmental abnormalities or infectious complications. Acquired aplastic anemia has a more favorable prognosis, since in some cases it is reversible after the cessation of the action of the damaging factor on the bone marrow.
Laboratory diagnostics doctor
Novopolotsk city hospital
Kostyuk K.S.
Possible consequences and risks
Despite its effectiveness, a spinal tap is a very dangerous procedure . Only an experienced specialist can perform a puncture correctly, because this requires not only special surgical instruments, but also deep knowledge in medicine. If the puncture technique is not followed or mistakes are made, serious complications can arise:
- Strong headache;
- the appearance of discomfort in the spine;
- internal bleeding;
- increased pressure in the cranium;
- formation of protrusions or hernias;
- the appearance of a tumor formation (cholesteatoma).
In some cases, the procedure can lead to serious complications
Patients often experience headaches after a spinal tap. In most cases, this symptom occurs due to the injected fluid entering nearby tissues. As a rule, headaches occur in a standing or sitting position, but pain can also appear when the patient is in a horizontal position. Based on all these adverse reactions, doctors strongly recommend limiting physical activity as much as possible for several days after the operation. During this period, it is advisable to observe bed rest.
Orthopedic mattresses
General anesthesia for lumbar puncture is not usually given
Another common ailment that can be encountered after a spinal tap is severe and persistent pain in the spine. At first it appears at the puncture site, but after a certain amount of time the pain spreads to other parts of the body (most often the pain affects the lower extremities).
Spinal pain
Complications
The most serious consequence of lumbar puncture is herniation. It can develop in patients with a volumetric process of the brain against the background of intracranial hypertension. With a sudden drop in pressure in the spinal canal, the uncus of the hippocampus becomes wedged into the notch of the tentorium of the cerebellum or the cerebellar tonsils into the foramen magnum or. If the cerebrospinal fluid pressure turns out to be high, only a minimal amount of cerebrospinal fluid is removed for examination, mannitol and glucocorticoids are prescribed, and the patient is monitored. If there is a high risk of herniation or deterioration of the patient’s condition during lumbar puncture, the needle with the inserted mandrin is left in place, mannitol and high doses of corticosteroids are administered intravenously, after which the needle is removed. Complete or partial blockade of the subarachnoid space, caused by compression of the spinal cord, can cause herniation of the spinal cord with rapidly increasing focal symptoms.
Headaches after lumbar puncture occur in 10-30% of patients. They are associated with prolonged leakage of cerebrospinal fluid through a hole in the dura mater, which leads to a decrease in intracranial pressure. The pain is most often localized in the occipital and frontal region and occurs in the first three days after the puncture. How many days do you have a headache after a lumbar puncture? The headache usually lasts 2-5 days, but sometimes lasts for several weeks.
Back pain after lumbar puncture is associated with damage to the spinal cord roots. Sometimes there is a transient lesion of the abducens nerve, accompanied by the appearance of paralytic convergent strabismus and double vision. If the needle passes through infected tissue, meningitis may develop. Local complications of lumbar puncture in the form of redness at the puncture site are rare and do not require treatment.
Doctors at the Neurology Clinic will perform a lumbar puncture. Get a consultation with a neurologist by first making an appointment by phone at the Yusupov Hospital.
Features of spinal puncture
It is worth noting that this procedure does not require special preparation and is performed in a hospital setting. All manipulations are performed by a qualified specialist. The patient is initially given a local anesthetic, but the procedure is often performed without anesthesia. For convenience, the patient should lie sideways on the bed or sit on a chair. In this case, the back should be bent at the maximum permissible angle, since with such a bend a necessary gap appears between the vertebrae, through which the doctor inserts a needle into the spinal canal. Of course, the area of the body to be operated on is thoroughly disinfected beforehand.
Are there any contraindications?
There are certain contraindications to performing a spinal puncture, which must be taken into account. For example, the procedure is prohibited from being performed if there is a suspicion of brain stem symptoms or brain dislocation. Also, puncture is not recommended when pictorial pressure decreases. Otherwise there may be serious consequences. When the pressure in the spiral volume decreases, the brain column is pinched, against which the operation can be fatal.
Contraindications for puncture
When performing a spinal puncture, special attention must be paid to the tendency to bleeding and blood clotting disorders. Also, a few days before the operation, it is not recommended to take medications that thin the blood. The most common drugs in this group include Warfarin, Clopidogrel, Agrenox and others.
"Clopidogrel"
The use of some analgesic drugs should also be abandoned, for example, Aspirin, Asaphen and Naproxen.
"Naproxen"
Interpretation of sternal puncture results
Analysis of bone marrow obtained through sternal puncture shows the number of cellular elements in it, their ratio and degree of maturity. The myelogram characterizes the qualitative and quantitative indicators of the white germ of hematopoiesis:
- Myelokaryocytes (the total number of blood cells containing nuclei) are 50-250x109 per liter of blood;
- Megakaryocytes (precursors of platelets) - 0.054-0.074x106 per liter;
- Reticulocytes (precursors of red blood cells) make up 20-30% and increase with blood loss and hemolytic anemia;
- Blast cells - 0.1-1.1%, myeloblasts - 0.2-1.7%, promyelocytes - 0.5-8.0% of all elements of the white sprout of the bone marrow, lymphocytes - 1.2-1.5 %, monocytes - 0.25-2.0%, plasma cells - no more than 1%.
A decrease in the number of myelokaryo- and megakaryocytes is possible due to errors in the puncture, when the bone marrow is diluted with liquid blood.
The specialist studying the bone marrow punctate reflects in the conclusion the type of hematopoiesis, cellularity, bone marrow indices, the presence and number of uncharacteristic cells (for example, Hodgkin's in lymphogranulomatosis). Each of the sprouts is analyzed separately.
Approximate cost of the procedure
Spinal puncture can be performed not only in public medical institutions, but also in private ones. In such cases, the difference may be in price, which will depend on various factors, for example, the nature of the procedure, the choice of clinic to perform it, as well as the complexity of the study and the level of qualifications of the doctor. If we talk about metropolitan clinics, the cost of a spinal puncture can vary from 3,000 to 5,000 rubles.
About the cost of a lumbar puncture
In other cities, prices are much lower - the average cost of an operation is approximately 1300-3000 rubles. Of course, when choosing a clinic for this procedure, the first thing you need to pay attention to is not the price tag, but the level of qualifications of the medical staff. It is recommended to read reviews from real clients, read information about the clinic itself and the doctor you are going to contact for help.
Prices for postoperative bandages