Such compensation can be effective only for a limited time, depending on the rate of growth of the SOL;. This is usually a safe procedure undertaken to acquire a sample of CSF for analysis, and is also sometimes done to measure CSF pressure or to introduce drugs into the CSF, a procedure known as intrathecal injection.
The insertion of a needle under local anaesthetic requires careful positioning to prevent injury to the spinal cord. Since the spinal cord ends as a solid structure around the level of the second lumbar vertebra L2 the insertion of a needle must be below this point, usually between L3 and L4 Fig 2.
The spinal cord continues below L2 down into the sacrum as many separate strands of nerve pathways, the cordae equina, bathed in CSF. Putting a needle into the spaces between the strands to collect fluid is much safer than taking the risk of hitting the solid cord higher up the spine.
The spinal vertebrae are held together by ligaments. Those penetrated in a lumbar puncture are the interspinous ligaments which bind adjacent spinous processes together and the ligamentum flavum which binds adjacent vertebral laminae together and, in so doing, lines the posterior wall of the spinal canal.
Lumbar puncture must be carried out as a sterile procedure, with full aseptic precautions to prevent the introduction of outside organisms into the spinal canal and the contamination of the specimens collected. The patient must be either:. The latter position curves the spine anteriorly, providing the maximum room between the vertebral processes to allow the insertion of the needle.
It may be necessary for the nurse to assist the patient into this position, and give them support to maintain it during the procedure. Placing the patient towards the edge of the bed gives the doctor easy access. The correct site is determined by imagining a line drawn from one iliac crest to the other anterosuperior iliac spines , and identifying where this line crosses the lumbar spine.
This is around the level of L3, and can be confirmed by counting the lumbar vertebral neural spines that can be seen and felt extending into the skin. The lumbar area is cleaned with an appropriate antiseptic before local anaesthetic is instilled into the skin and deeper tissues, and given a few minutes to act.
The needle is then inserted into the intravertebral space between L3 and L4. It will penetrate the skin, then the subcutaneous tissues, the interspinous ligaments and the ligamentum flavum before passing through the dura and arachnoid maters and entering the subarachnoid space and the CSF.
CSF pressure can be measured with a manometer. When this is removed, the fluid is allowed to drip into sterile containers that are sealed and labelled. The samples are used for cell counts, cytology, glucose and protein measurements and sometimes immunoglobulin studies. They may also be taken for bacteriological or viral tests, and for biochemical analysis. After the procedure has been completed, the needle is removed and a small local dressing applied to absorb any CSF or blood leakage.
The patient should remain flat for six to 12 hours because headache, which is common after lumbar puncture, is aggravated by sitting up. Headaches may be severe and may require treatment with analgesia Hickey, Your doctor will collect between 5 to 20 ml of cerebrospinal fluid in 2 to 4 tubes.
You will probably feel pressure when the needle is inserted, and some people feel a sharp stinging sensation when the needle goes through the protective dural layer that surrounds the spinal cord.
Although you may feel some discomfort, it is important that you lie still. Let your doctor know if you are feeling pain. Step 3: measure CSF pressure optional You will be asked to straighten your legs to decrease abdominal pressure and increase cerebrospinal fluid pressure.
The needle is attached to a meter and the pressure in your spinal canal is measured. Step 4: insert a lumbar drain optional In cases of hydrocephalus, a catheter may be inserted to continuously remove CSF and relieve pressure on the brain.
The doctor will apply pressure to the puncture site, then apply a bandage. You will need to rest in bed for at least an hour, and avoid strenuous activity for at least 24 hours.
You should also drink plenty of fluids. Let your doctor know if any blood or fluid is leaking from the puncture site. A lumbar puncture is safe for most people. Some people get a severe headache known as a "spinal headache" caused by CSF leakage.
Rare complications include back or leg pain, accidental puncture of the spinal cord, bleeding in the spinal canal, and brain herniation caused by a sudden decrease of CSF pressure. The doctor will get immediate information from the color of the CSF, which is normally clear.
A reddish color indicates a bleed or subarachnoid hemorrhage. A cloudy or yellowish color indicates an infection, possibly meningitis. Thorough analysis by a laboratory will detect substances such as antibodies, blood, sugar, bacteria, cancer cells, and excess protein or white blood cells. The laboratory test results can take longer and will be discussed with you when completed. Author information Article notes Copyright and License information Disclaimer.
BT63 5QQ. Correspondence to Raeburn B. Forbes ten. Accepted Mar 6. This article has been cited by other articles in PMC. Abstract Diagnostic Lumbar Puncture is one of the most commonly performed invasive tests in clinical medicine. Open in a separate window. Fig 1. The lumbar puncture proforma currently in use in Craigavon Area Hospital. Fig 2. Fig 3. Fig 4. Fig 5. The distance from surface to Ligamentum Flavum is approximately 55mm.
Test Utility Volume Form Additional Microbiology Cell count, culture and sensitivity 20 drops Microbiology Biochemistry Protein and glucose 20 drops Biochemistry Paired serum protein and glucose samples Xanthochromia Spetrophotometry 20 drops in each of 3 serially numbered bottles Biochemistry Transport in opaque envelope or wrap sample container in foil. Fig 6. Fig 7. Equipment needed for Lumbar Puncture CSF Specimen Bottles Serum Specimen Bottles, 8 Serum glucose bottle fluoride oxalate 9 Syringe for local anaesthetic 10 Introducer for spinal needle not always required 19G and 25G hypodermic needles to draw up and inject anaesthetic 13 Whitacre 22G spinal needle atraumatic needle 14 Quincke 20G spinal needle no longer recommended 15 Manometer with 3-way tap.
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