How bad does a spinal tap hurt. Everything You Need to Know About Lumbar Punctures: A Comprehensive Guide
What is a lumbar puncture? How bad does a spinal tap hurt? Get answers to these questions and more in our detailed guide on lumbar punctures.
Understanding Lumbar Punctures
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 to collect cerebrospinal fluid or measure its pressure. This procedure is often used to diagnose or treat various conditions, such as infections, neurological disorders, and certain types of cancer.
When is a Lumbar Puncture Needed?
Lumbar punctures may be used for several purposes, including:
- Taking a sample of cerebrospinal fluid to help diagnose a condition
- Injecting medication, such as painkillers, antibiotics, or chemotherapy
- Injecting a spinal anesthetic to numb the lower part of the body before an operation
- Removing fluid to reduce pressure in the skull or spine
Preparing for a Lumbar Puncture
Before a lumbar puncture, your doctor or nurse will explain the procedure and why it is necessary. You may also need to undergo a CT scan or MRI to ensure the procedure is safe. Additionally, you should inform the hospital if you are taking any blood-thinning medications, such as warfarin.
What Happens During a Lumbar Puncture?
During the procedure, you will typically lie on your side with your legs pulled up and your chin tucked in. The doctor or nurse will clean the area, numb it with a local anesthetic, and then insert a thin needle between the bones in your lower spine. This should not be painful, but you may feel some pressure.
How Long Does a Lumbar Puncture Take?
A lumbar puncture typically takes around 30 to 45 minutes. After the procedure, 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.
Side Effects and Recovery
The most common side effects of a lumbar puncture are headaches, swelling, and lower back pain, which can last for up to a week. To help with recovery, you should drink plenty of fluids, take painkillers, lie down instead of sitting upright, and try drinks containing caffeine.
If you experience severe headaches, nausea, a high temperature, or see blood or clear fluid leaking from your back, you should contact the hospital team or your GP immediately.
How Bad Does a Spinal Tap Hurt?
A lumbar puncture should not be painful, but you may feel some pressure during the procedure. The most common side effect is a headache, which can be managed with painkillers. While the procedure itself is not usually painful, the discomfort experienced can vary from person to person.
Frequently Asked Questions
What is the difference between a lumbar puncture and a spinal tap?
A lumbar puncture and a spinal tap are the same procedure. They both involve inserting a thin needle between the bones in the lower spine to collect cerebrospinal fluid or measure its pressure.
Can a lumbar puncture cause permanent damage?
Serious complications from a lumbar puncture are rare, but they can occur. Potential complications include bleeding, infection, and nerve damage. However, these complications are uncommon, and the procedure is generally considered safe when performed by a trained medical professional.
How long does it take to recover from a lumbar puncture?
Most people are able to go home the same day as their lumbar puncture, but they may need to rest for a few days. The most common side effects, such as headaches and lower back pain, typically resolve within a week.
Can you feel a lumbar puncture being done?
You should not feel pain during a lumbar puncture, but you may feel some pressure or discomfort as the needle is inserted. The area is numbed with a local anesthetic, so the actual insertion of the needle should not be painful.
How accurate are lumbar puncture results?
Lumbar punctures are generally considered a reliable and accurate diagnostic tool. The results can help doctors diagnose a wide range of conditions, such as infections, neurological disorders, and certain types of cancer. However, the accuracy of the results can depend on various factors, such as the specific condition being tested for and the skill of the medical professional performing the procedure.
Can you walk after a lumbar puncture?
Yes, most people are able to walk after a lumbar puncture, but you may need to rest for a while before doing so. You’ll typically be asked to lie down for at least an hour after the procedure while the nurses monitor you. If you feel well enough, you can then get up and walk, but you should not drive yourself home.
How long does it take to get lumbar puncture results?
The doctor or nurse who performs the lumbar puncture can often provide you with some initial results and an explanation of what they mean right away. However, you may need to wait at least 48 hours for the full laboratory test results. In emergency situations, some results may be available within a couple of hours.
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:
- 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.
- 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.
- 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
Heading: »» Articles on neurology Dubovskaya Nadezhda AlexandrovnaHead physician of the Clinic, neurologist Author of the article In the treatment of neurological and spinal diseases, lumbar puncture is often used as a diagnostic procedure. Lumbar puncture is a method for examining cerebrospinal fluid (CSF). Liquor is taken from the spinal canal after puncturing the soft tissues of the back, the ligaments of the spine and the membranes of the spinal cord at the level of the lumbar spine with a special needle. The technique of lumbar puncture involves the introduction of a special needle at the level where the spinal cord no longer exists, but only its processes (the so-called “cauda equina”). These are spinal roots located vertically in the spinal canal and exiting through special openings in the membranes of the spinal cord and intervertebral foramens outside the spine. What complications and side effects can occur? Another danger with lumbar puncture is that when the ligaments of the lumbar spine are punctured, their fixing (supporting) function is weakened. Weakening of the ligamentous apparatus of the spine can lead to the appearance of a herniated disc. In order to prevent this, the specialists of the Dr. Voight Clinic recommend not to lift weights after the puncture, not to work in a bent position, not to make sudden movements in the lumbar spine, to avoid axial loads on the spine (running, jumping). In the Dr. Voight Clinic, in case of damage to the ligamentous apparatus of the spine and joints, complex treatment is used according to the patented method of MD. professor, member of the Academic Council of the Military Medical Academy Voytsitsky A. However, the most common complaint after a lumbar puncture is not related to the puncture site in the lumbar region – it is a headache. The fact is that a lumbar puncture is taken in order to take cerebrospinal fluid (CSF) for analysis. Normally, CSF circulates between the brain and spinal cord, providing their nutrition. During lumbar puncture, several milliliters of CSF are collected in a test tube for analysis. Thus, the volume of circulating cerebrospinal fluid decreases. CSF pressure drops in the central nervous system (not to be confused with blood pressure!) and a headache appears. The prevention of this complication is simple: after the puncture, it is necessary to drink 2 liters of still water for several hours or inject the liquid intravenously. The patient is advised to lie down for an hour. Differential diagnosis and treatment of what diseases is possible with the help of lumbar puncture? Unfortunately, there are a number of diseases of the nervous system in which lumbar puncture is the only study that reliably confirms or excludes the diagnosis. Thus, lumbar puncture is mandatory for all patients with suspected infectious and autoimmune diseases of the central nervous system, if necessary, to differentiate tumor diseases of the spine, spinal cord, spinal cord membranes before deciding on surgical intervention. Sometimes, during a lumbar puncture for a herniated disc, doctors inject drugs into the spinal canal to help reduce pain. However, it must be remembered that pain relief is not a cure. With a decrease in pain and the preservation of the pathological process in the spine (for example, in the case of intervertebral hernia), the protective function of pain also decreases – the person begins to move more and increase injury to the ligamentous apparatus of the spine. In this article we have tried to answer your questions:
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They don’t come close to each other. It is very difficult to damage these roots during a lumbar puncture. However, such a danger exists. Then the person may experience pulling pains in the leg.
N. Limitation of physical activity and loads in combination with complex treatment at the Dr. Voight Clinic helps to restore the integrity of the ligamentous apparatus of the spine.
If the doctor has prescribed a diagnostic lumbar puncture, you can ask him in detail about the indications, contraindications, possible complications and the feasibility of this manipulation.
It is not necessary to immediately refuse to perform a lumbar puncture, perhaps in this particular situation it will be more useful than harmful. Timely correct diagnosis is the key to successful treatment and your speedy return to active life!
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