How does a lumbar puncture work. What are the potential side effects of a spinal tap. How long does recovery from a lumbar puncture typically take. What should you do to prepare for a lumbar puncture procedure. When might a doctor recommend getting a spinal tap.

What is a Lumbar Puncture and Why is it Performed?

A lumbar puncture, also known as a spinal tap, is a medical procedure where a thin needle is inserted between the bones in the lower spine. This procedure serves several important purposes in diagnosing and treating various medical conditions.

Common reasons for performing a lumbar puncture include:

• Collecting a sample of cerebrospinal fluid for analysis
• Measuring the pressure of the cerebrospinal fluid
• Administering medications directly into the spinal canal
• Injecting spinal anesthesia
• Relieving pressure in the skull or spine

Understanding the purpose of a lumbar puncture can help alleviate concerns and prepare patients for the procedure. While the thought of a needle being inserted into the spine may seem daunting, it’s important to note that the procedure is generally safe and should not be excessively painful when performed correctly.

Preparing for Your Lumbar Puncture: What to Expect

Proper preparation is key to ensuring a smooth lumbar puncture experience. Here’s what you can expect in the lead-up to your procedure:

Before the Procedure

Your healthcare provider will explain the process and address any concerns you may have. In some cases, you may undergo imaging tests such as a CT scan or MRI to ensure the procedure is necessary and safe for you.

If you’re taking blood-thinning medications, it’s crucial to inform your doctor well in advance. They may advise you to temporarily discontinue these medications to reduce the risk of complications.

On the Day of the Procedure

Unlike some medical procedures, a lumbar puncture doesn’t require fasting. You can eat, drink, and take your regular medications as normal. Upon arrival at the hospital:

• You’ll be asked to sign a consent form
• You’ll change into a hospital gown
• It’s advisable to use the restroom before the procedure

By knowing what to expect, you can approach the procedure with greater confidence and less anxiety.

The Lumbar Puncture Procedure: Step-by-Step Guide

Understanding the steps involved in a lumbar puncture can help demystify the procedure and ease any apprehensions. Here’s a detailed breakdown of what happens during a typical lumbar puncture:

1. Positioning: You’ll be asked to lie on your side with your knees pulled up towards your chest and your chin tucked in. This position helps to widen the spaces between the vertebrae, making it easier to insert the needle.
2. Sterilization: The area of your lower back where the needle will be inserted is thoroughly cleaned with an antiseptic solution to prevent infection.
3. Local Anesthesia: A local anesthetic is injected to numb the area. You may feel a brief sting, but this ensures that the rest of the procedure is more comfortable.
4. Needle Insertion: Once the area is numb, the doctor will carefully insert a thin needle between two vertebrae in your lower spine. You might feel some pressure, but it shouldn’t be painful.
5. Fluid Collection or Medication Administration: Depending on the purpose of the procedure, the doctor will either collect a sample of cerebrospinal fluid or administer medication.
6. Needle Removal: After the necessary samples are collected or medications administered, the needle is gently removed.
7. Dressing Application: A small bandage is applied to the insertion site.

The entire procedure typically takes between 30 to 45 minutes. Following the lumbar puncture, you’ll be asked to lie flat for about an hour to allow the insertion site to seal and to monitor for any immediate side effects.

Managing Pain and Discomfort During and After a Lumbar Puncture

One of the most common concerns patients have about lumbar punctures is the potential for pain. While it’s natural to feel apprehensive, it’s important to understand that severe pain is not typical during or after the procedure.

During the Procedure

Thanks to the local anesthetic, you shouldn’t feel sharp pain during the lumbar puncture. However, you may experience:

• A brief sting when the local anesthetic is injected
• Pressure sensation as the needle is inserted
• Mild discomfort or an odd sensation in your legs as the needle is positioned

After the Procedure

Post-procedure discomfort is usually mild to moderate and can include:

• Headaches, which can last up to a week
• Lower back pain or tenderness at the injection site
• Mild nausea

To manage these symptoms:

• Take over-the-counter pain relievers like paracetamol
• Stay hydrated by drinking plenty of fluids
• Rest and avoid strenuous activities for a day or two
• Try caffeine-containing beverages, which may help alleviate headaches

If you experience severe pain, persistent nausea, fever, or any unusual symptoms, contact your healthcare provider immediately.

Potential Side Effects and Complications of Lumbar Punctures

While lumbar punctures are generally safe procedures, it’s important to be aware of potential side effects and complications. Most side effects are mild and resolve on their own, but understanding what to look out for can help you seek timely medical attention if needed.

Common Side Effects

• Post-Dural Puncture Headache: This is the most common side effect, occurring in up to 40% of patients. It typically starts within 48 hours of the procedure and can last up to a week. The headache may worsen when sitting or standing up.
• Back Pain: Localized pain or tenderness at the injection site is normal and usually resolves within a few days.
• Bleeding: Minor bleeding at the puncture site is possible but rarely significant.

Less Common Complications

• Infection: Although rare, there’s a small risk of infection at the puncture site or in the cerebrospinal fluid (meningitis).
• Nerve Damage: In very rare cases, the needle may irritate or damage a spinal nerve, causing temporary or permanent symptoms like numbness or weakness.
• Cerebral Herniation: Extremely rare but serious, this can occur in patients with certain brain conditions that increase intracranial pressure.

Being aware of these potential complications doesn’t mean you should expect them to occur. The vast majority of lumbar punctures are performed without significant issues. However, if you experience severe symptoms or are concerned about any aspect of your recovery, don’t hesitate to contact your healthcare provider.

Recovery and Aftercare: Ensuring a Smooth Healing Process

Proper aftercare is crucial for a smooth recovery following a lumbar puncture. While most patients can return home the same day as the procedure, it’s important to follow specific guidelines to minimize discomfort and reduce the risk of complications.

Immediate Post-Procedure Care

After the lumbar puncture, you’ll need to:

• Lie flat for at least an hour to allow the puncture site to seal
• Have someone drive you home, as you shouldn’t drive yourself
• Rest for the remainder of the day

In the Days Following

To promote healing and manage any discomfort:

• Drink plenty of fluids to help replenish cerebrospinal fluid and potentially reduce headaches
• Take pain relievers as recommended by your doctor
• Avoid strenuous activities for a couple of days
• Remove the bandage or dressing the day after the procedure

It’s normal to experience some mild back pain or a headache for a few days after the procedure. However, if you encounter any of the following symptoms, contact your healthcare provider immediately:

• Severe or persistent headaches
• High fever
• Stiff neck
• Difficulty looking at bright lights
• Persistent back pain or swelling
• Numbness or tingling in your legs
• Drainage from the puncture site

By following these aftercare instructions and staying vigilant for any unusual symptoms, you can ensure a smoother recovery process and quickly address any potential complications.

When to Seek Medical Attention After a Lumbar Puncture

While most people recover from a lumbar puncture without significant issues, it’s crucial to know when to seek medical attention. Recognizing the signs that something might be amiss can help prevent more serious complications.

Red Flags to Watch For

Contact your healthcare provider or seek immediate medical attention if you experience:

• Severe Headaches: Especially if they don’t respond to over-the-counter pain relievers or worsen when you sit up or stand
• Fever: A temperature over 38°C (100.4°F) could indicate an infection
• Neck Stiffness: This could be a sign of meningeal irritation or infection
• Numbness or Weakness: Particularly in your legs or lower body
• Vision Changes: Including blurred vision or sensitivity to light
• Persistent Nausea or Vomiting: Especially if accompanied by a headache
• Drainage from the Puncture Site: Particularly if it’s clear fluid (which could be cerebrospinal fluid) or appears infected
• Severe Back Pain: Especially if it’s getting worse instead of better

Assessing Pain Severity

Understanding the difference between expected discomfort and concerning pain is important:

• Mild Pain: Comes and goes, is annoying but manageable
• Moderate Pain: Constant, makes it hard to concentrate or sleep, but you can still perform daily activities
• Severe Pain: Constant and intense, making it difficult to think, talk, or perform basic tasks

If you’re experiencing severe pain or are unsure about your symptoms, it’s always better to err on the side of caution and seek medical advice. Your healthcare provider can assess your symptoms and determine if further intervention is necessary.

Understanding Lumbar Puncture Results: What They Mean for Your Health

The results of a lumbar puncture can provide valuable insights into your health and help guide treatment decisions. Understanding what these results mean can empower you to have more informed discussions with your healthcare provider.

Immediate Results

Some information can be gathered immediately during the procedure:

• Opening Pressure: This measures the pressure of your cerebrospinal fluid (CSF) and can indicate conditions like hydrocephalus or intracranial hypertension.
• Visual Appearance of CSF: Normal CSF is clear and colorless. Cloudiness or unusual coloration can suggest infection or bleeding.

Laboratory Analysis

More detailed results typically take at least 48 hours and may include:

• Cell Count: An elevated white blood cell count may indicate infection or inflammation.
• Glucose Levels: Low glucose in CSF can be a sign of bacterial meningitis or other infections.
• Protein Levels: Elevated protein might suggest inflammation, infection, or certain neurological disorders.
• Cultures: These can identify specific bacteria or fungi if an infection is present.
• Specialized Tests: Depending on the suspected condition, tests for specific proteins, antibodies, or markers may be performed.

Interpreting Your Results

Your healthcare provider will interpret your results in the context of your overall health and symptoms. They may use these results to:

• Confirm or rule out suspected conditions
• Guide treatment decisions
• Monitor the progression of certain diseases
• Evaluate the effectiveness of ongoing treatments

It’s important to remember that lumbar puncture results are just one piece of the diagnostic puzzle. Your doctor will consider these results alongside other tests, your medical history, and your symptoms to provide a comprehensive assessment of your health.

If you have questions about your lumbar puncture results or what they mean for your health, don’t hesitate to ask your healthcare provider for clarification. Understanding your results can help you take an active role in your healthcare decisions and treatment plan.

Lumbar puncture – NHS

A lumbar puncture is where a thin needle is inserted between the bones in your lower spine. It should not be painful, but you may have a headache and some back pain for a few days.

It’s carried out in hospital by a doctor or specialist nurse.

When a lumbar puncture may be needed

A lumbar puncture may be used to:

• take a sample of fluid from your spinal cord (cerebrospinal fluid) or measure the fluid’s pressure – to help diagnose a condition
• inject medicine – such as painkillers, antibiotics or chemotherapy
• inject a spinal anaesthetic – to numb the lower part of your body before an operation
• remove some fluid to reduce pressure in the skull or spine

Before having a lumbar puncture

Your doctor or nurse should explain what’s going to happen and why you need a lumbar puncture.

A few days or weeks before the test:

• you may have a CT scan or MRI scan – to make sure you need the lumbar puncture and it’s safe to have one
• let the hospital know if you’re taking blood-thinning medicine (anticoagulants) – such as warfarin

On the day:

• you can eat, drink and take medicine as normal
• you’ll be asked to sign a consent form
• you’ll usually need to undress and change into a hospital gown before the procedure – you might also want to use the toilet

What happens during a lumbar puncture

You normally lie on your side, with your legs pulled up and your chin tucked in

Credit:

PETER GARDINER/SCIENCE PHOTO LIBRARY https://www.sciencephoto. com/media/137879/view

This allows the needle to be inserted between the bones more easily

Credit:

PETER GARDINER/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/137879/view

The doctor or nurse will:

1. Clean your skin and numb the area with local anaesthetic (you’ll be awake during the procedure). Children may also be given medicine to help them relax and keep still.
2. Insert a thin needle through the skin, between 2 bones in the lower part of your spine. This should not be painful, but you may feel some pressure.
3. Remove the needle once the procedure is finished and apply a small plaster or dressing.

How long does a lumbar puncture take?

A lumbar puncture takes around 30 to 45 minutes, but you’ll need to stay lying down at the hospital for at least another hour while the nurses monitor you.

You’ll be able to go home the same day if you feel well enough, but you would not be able to drive yourself home.

Getting the results

The doctor or nurse who performs the lumbar puncture can often tell you some of the results straight away and explain what they mean.

You may need to wait for at least 48 hours for the full results. Some laboratory test results are available within a couple of hours in an emergency.

Side effects of a lumbar puncture

A lumbar puncture is generally a safe procedure and serious side effects are uncommon.

The most common side effects are:

• headaches, which can last for up to a week – you’ll be given painkillers at the hospital if you need them
• swelling and lower back pain where the needle was inserted – this should get better on its own after a few days and is normally nothing to worry about

Recovering from a lumbar puncture

While you’re recovering from a lumbar puncture:

Do

• drink plenty of fluids

• take painkillers, such as paracetamol

• lie down instead of sitting upright

• try drinks containing caffeine, such as coffee, tea or cola – some people find this helps to relieve the headaches

• remove the dressing or plaster yourself the next day

Non-urgent advice: Contact the hospital team or a GP if:

• your headaches are severe or do not go away
• you’re feeling or being sick
• you have a very high temperature or feel hot and shivery
• it’s painful to look at bright lights
• the swelling in your back lasts for more than a few days or keeps getting worse
• you see blood or clear fluid leaking from your back

What we mean by severe pain

Severe pain:

• always there and so bad it’s hard to think or talk
• you cannot sleep
• it’s very hard to move, get out of bed, go to the bathroom, wash or dress

Moderate pain:

• always there
• makes it hard to concentrate or sleep
• you can manage to get up, wash or dress

Mild pain:

• comes and goes
• is annoying but does not stop you doing daily activities

Page last reviewed: 19 February 2021
Next review due: 19 February 2024

What to Expect From a Spinal Tap

You may have heard of a spinal tap or lumbar puncture. Here’s what it’s all about.

Odds are you’ve heard of a spinal tap—but you may not know exactly what it entails. Also called a lumbar puncture, it’s a procedure performed in the lower part of your back to diagnose a health problem, administer medicine, or assist with imaging.

During a spinal tap, a doctor or specially trained nurse inserts a needle between your vertebrae to collect cerebrospinal fluid (CSF). This colorless, watery substance cushions your spinal cord and brain, safeguarding them from damage.

When might someone need a spinal tap? Is it dangerous? And what can you expect before, during and after the procedure?

Spinal taps are often done to help diagnose infections of the central nervous system (CNS).

“One of the most common reasons for doing a lumbar puncture is for meningitis,” says Jeff Gadsden, M.D., FRCPC, FANZCA, division chief of Orthopaedic, Plastic and Regional Anesthesiology at Duke University Medical Center in Durham, NC.

“We’ll take a sample of cerebrospinal fluid,” he explains, “and if we see certain infectious organisms growing in it, that gives us a clue as to how to tailor our antibiotic therapy. ”

The procedure can also help providers:

• Identify certain CNS disorders, such as multiple sclerosis, Guillain-Barré syndrome or epilepsy

• Diagnose cancers affecting the brain or spinal cord

• Administer chemotherapy or anesthesia

It can help with imaging, as well. A provider may inject contrast agents (dyes) into the CSF “if they’re trying to get an anatomic view of the spinal cord and the coverings of the spinal cord,” Dr. Gadsden says. It’s particularly helpful when a patient can’t undergo an MRI.

A spinal tap can be done in a hospital or outpatient facility, depending on why it’s needed. It’s not an emergency procedure.

“We think about emergencies, that brings to mind the sort of things that have to be done within seconds to minutes, and that’s never the case for a lumbar puncture,” Dr. Gadsden explains. “I would characterize it more as an urgent procedure—something that we would want to do in the timeframe of hours rather than minutes. ”

In the days leading up to your spinal tap, follow your provider’s instructions regarding eating and drinking. You may be asked to hold off in the hours beforehand. Tell your health care team about any prescription or over-the-counter medications you’re currently taking—especially blood thinners. Let them know about any drug allergies, too.

“Patients can wear their own clothes” says Dr. Gadsden. “When they show up to the hospital, they’re put into a gown for the procedure.”

The morning of your appointment, call your doctor with any unusual symptoms. If you feel ill, do not go to the hospital without reaching out first. Make sure someone is available to drive you home following your visit, Gadsden suggests, “because sometimes you can feel a bit weak and dizzy afterwards.”

A spinal tap is a relatively simple procedure. It typically takes less than 30 minutes to complete.

To begin, you will sit bending forward or lie on your side in a fetal position.

“We want your knees pulled up as far as possible and your chin down to your chest so you’re curled up into a little ball,” says Dr. Gadsden. This arcs your back and spaces out your vertebrae, so your doctor has a bigger area to aim for.

After the skin on your back is cleaned with an antiseptic, a sterile sheet or towels will be placed over you, with an opening over your lower spine. Your doctor will then inject you with a local anesthesia to numb the area. You may feel a stinging sensation, explains Dr. Gadsden, “but then the patient shouldn’t feel the actual spinal needle all that much as it advances between the two bones.”

“Then, the needle itself gets inserted into the skin between the bones in the lower back, and into the spinal space where the cerebrospinal fluid lives,” he continues. In certain situations, an ultrasound or special X-ray imaging technique called fluoroscopy is used to determine the best position for the spinal needle.

How a spinal tap is performed

Once the needle is in, the doctor will measure your CSF pressure. At this point, medicine will be administered (if that’s why you’re there) or a sample of CSF will be taken.

“We’ll collect a teaspoonful, usually—it’s all we really need,” Dr. Gadsden says. “And then the needle comes out. Put a little Band-Aid on the skin and we’re all done.”

Unless your doctor instructs you to move, it is important that you remain still during a spinal tap.

“We are trying to advance the needle into a fairly discrete and small area that contains that cerebrospinal fluid,” he says. If you do move, you will likely not be injured, since a spinal tap occurs below where the spinal cord ends. But, he explains, “it helps us to complete the procedure faster and more efficiently if you don’t move.”

Spinal tap pain is rare, though sometimes the needle may brush by a nerve root as it’s inserted.

“That can feel like a little zing or electric shock down one leg or the other. It’s not a dangerous thing. It’s not anything that went wrong. It’s just that those nerve roots live there,” Dr. Gadsden says.

Once your spinal tap is finished, you will lie on your back for 30 to 60 minutes so your doctor can look for any adverse effects. Whether you’re allowed to go home depends on the reason for the spinal tap.

“If a patient’s coming with an unexplained fever and a concern for meningitis, then they’re probably not a patient we’re going to send home from the hospital,” says Dr. Gadsden.

If your spinal tap was an outpatient procedure, you should be able to leave the facility and resume simple activities after taking a few hours to relax. Pain medication can usually address any discomfort.

Speak with your provider about when you can expect results. “It can be a day up to a week,” says Gadsden. Again, it depends on why you received the spinal tap.

Spinal taps are safe procedures with rare complications. The most common is a headache, which affects 10% to 30% of patients and “usually comes on after several hours, sometimes a day or two later,” Gadsden says. “It is not dangerous. It doesn’t lead to any neurologic problems and it’s not unsafe. It’s just literally a headache.”

Drinking water, coffee, tea, or soda may prevent or ease the headache. An over-the-counter pain reliever can help, as well. If it continues after two days, reach out to your doctor, as it could signal a serious problem.

There is a very small possibility of more severe complications following a spinal tap, including infection, bleeding, numbness, and brain herniation (movement of the brain tissue due to pressure). Nerve or spinal cord damage is extremely uncommon.

“The most important thing is to not be afraid of it,” Dr. Gadsden says. “It’s a very safe thing to do. There are very few complications and they’re rare. And most people doing this are careful and gentle and it should not lead to a lot of discomfort or anxiety if done properly.”

Notes: This article was originally published June 26, 2020 and most recently updated June 29, 2020.

Cancer Research UK. (2018) “Lumbar puncture.” https://cancerresearchuk.org/about-cancer/cancer-in-general/tests/lumbar-puncture
Centers for Disease Control and Prevention. (2020) “Coronavirus Disease (2019)/COVID-19: What to Do If You Are Sick. ”
KidsHealth. (n.d.) “Spinal Tap (Lumbar Puncture).” https://kidshealth.org/en/parents/emmi-lumbar-puncture.html
Mayo Clinic. (2018) “Lumbar puncture (spinal tap).” https://mayoclinic.org/tests-procedures/lumbar-puncture/about/pac-20394631
MedlinePlus. (2018) “Brain herniation.” https://medlineplus.gov/ency/article/001421.htm
MedlinePlus. (2019) “Cerebral spinal fluid (CSF) collection.” https://medlineplus.gov/ency/article/003428.htm
MedlinePlus. (2019) “Lumbar puncture (spinal tap).” https://medlineplus.gov/ency/imagepages/19078.htm
UpToDate. (2020) “Lumbar puncture: Technique, indications, contraindications, and complications in adults.” https://uptodate.com/contents/lumbar-puncture-technique-indications-contraindications-and-complications-in-adults
Nursing Times Innovations. (2018.) “Training advanced practitioners to perform lumbar puncture.” https://www.nursingtimes.net/clinical-archive/neurology/training-advanced-practitioners-to-perform-lumbar-puncture-22-10-2018/

Our Review Process

Lumbar puncture – preparation, indications and performance of a puncture in Moscow

Lumbar puncture is performed to collect cerebrospinal fluid (CSF) (synonymous with CSF) that bathes the brain and spinal cord. Normally, viruses, bacteria, inflammatory cells – leukocytes, and oligoclonal antibodies should not be detected in the cerebrospinal fluid. If we find any pathological agent in the cerebrospinal fluid, then it becomes possible to accurately determine the cause of the disease. For example, the detection of oligoclonal antibodies and the 2nd type of their synthesis makes it possible to establish the diagnosis of multiple sclerosis with a high probability.

How is the procedure carried out?

The patient is asked to lie on his side, bend his head and press his bent knees to his stomach, ie. assume the fetal position. Sometimes the puncture is done in a sitting position, then they are also asked to lean forward as much as possible. Flexion of the back is necessary in order to increase the distance between adjacent vertebrae in the lumbar region and to reduce the distance from the skin to the spinal canal. Before the puncture, local anesthesia is performed. I perform a puncture in the lower back into the space between the spinal processes of 5 or 4 lumbar vertebrae. You may feel some discomfort during the insertion of the needle, but there is usually no pain due to local anesthesia. After the needle enters the spinal canal, cerebrospinal fluid begins to drain from the lumen of the needle. Usually 3-5 ml of liquid is taken. The entire procedure usually takes about 10 minutes. Within a day or two after the puncture, discomfort at the injection site may disturb. However, pain is more likely associated with the irritating effect of the anesthetic than directly with microtrauma when the needle is inserted. They try to perform the puncture in the morning in order to have time to send the CSF sample to the laboratory.

Is it possible to damage the spinal cord during a puncture?

Despite the fact that the needle is inserted into the space where the spinal cord is located, its injury is excluded during the standard CSF collection procedure in adults. The fact is that the spinal cord fills the canal throughout only in infants. The growth of the spine significantly outstrips the growth of the spinal cord, so the latter, as it were, “lifts up”, and its lower border is at the level of the 1st lumbar vertebra. The remaining space is a fluid-filled sac that contains the spinal nerve roots that travel down to “their” foramina in the spine. It is as difficult to damage a spine with a needle as it is to pierce vermicelli in broth with a needle. Trauma to the intervertebral disc is excluded, since the needle is inserted from the opposite side of the vertebra.

What side effects can be expected after the puncture?

The most common (approximately 20% of patients) adverse effect of a lumbar puncture is headache. A decrease in CSF pressure can cause irritation of the meninges containing pain receptors. This pressure drop is most significant when moving to a vertical position. Therefore, immediately after the puncture, it is necessary to lie down for 2 hours. Also, over the next 2-3 days, it is recommended to exclude physical activity and, if possible, lie down 2-3 times a day for 30 minutes. Headache occurs in an upright position and disappears in a horizontal position. Conventional pain medications for post-puncture headache are usually ineffective, the best treatment is to lie down.

How much CSF is taken during a lumbar puncture?

Total adult CSF volume is 140 to 270 ml. 600-700 milliliters of fluid are produced daily, that is, the cerebrospinal fluid is completely renewed about 4 times a day. During a lumbar puncture, 3-5 ml of fluid is usually removed. Thus, the extracted volume of CSF is rather insignificant in comparison with the total volume of its circulation. It is preferable to perform a lumbar puncture with the thinnest possible needle so that CSF does not leak through the puncture. To quickly replenish the volume of cerebrospinal fluid, you can speed up its production. To this end, it is recommended to take a sufficient amount of liquid (at least 2 liters of mineral water per day), as well as coffee (2-3 cups per day).

How important is a lumbar puncture?

Although lumbar puncture is an invasive procedure, it is generally well tolerated, no more painful than blood sampling, and the diagnostic information obtained after lumbar puncture is invaluable. And this, in turn, speeds up the diagnosis and allows you to prescribe treatment as early as possible.

Lumbar puncture

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