What is a lumbar puncture and why is it performed. How is a spinal tap carried out and what can patients expect during the procedure. What are the potential side effects of a lumbar puncture and how long does recovery typically take.

Understanding Lumbar Puncture: A Comprehensive Guide

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 is performed in a hospital setting by a doctor or specialized nurse. While it may cause some discomfort, it should not be excessively painful. Patients might experience headaches and mild back pain for a few days following the procedure.

The Purpose and Indications for Lumbar Puncture

Lumbar punctures serve various medical purposes. They are commonly used to:

• Collect a sample of cerebrospinal fluid (CSF) for analysis
• Measure the pressure of the CSF
• Administer medications directly into the spinal canal
• Inject spinal anesthetics
• Relieve intracranial pressure

These procedures play a crucial role in diagnosing conditions affecting the central nervous system, delivering targeted treatments, and preparing patients for certain surgeries.

Diagnostic Applications of Lumbar Puncture

When used for diagnostic purposes, a lumbar puncture can help identify various neurological conditions. The analysis of the cerebrospinal fluid can reveal infections, inflammatory diseases, and even certain types of cancers affecting the brain or spinal cord.

Therapeutic Uses of Spinal Taps

In addition to diagnosis, lumbar punctures are utilized for therapeutic purposes. They allow for the direct administration of medications into the cerebrospinal fluid, which can be particularly effective for certain treatments, such as chemotherapy for brain cancers or antibiotics for meningitis.

Preparing for a Lumbar Puncture: What Patients Need to Know

Prior to undergoing a lumbar puncture, patients should be well-informed about the procedure. The healthcare provider will explain the process and its necessity. In some cases, additional imaging tests like CT or MRI scans may be required to ensure the safety and appropriateness of the procedure.

Important considerations for patients include:

• Informing the medical team about any blood-thinning medications being taken
• Eating and drinking normally on the day of the procedure
• Signing a consent form
• Changing into a hospital gown before the procedure

Being prepared and understanding what to expect can help alleviate anxiety and ensure a smoother experience for the patient.

The Lumbar Puncture Procedure: Step-by-Step Breakdown

The lumbar puncture procedure typically follows a specific sequence of steps to ensure patient comfort and procedural accuracy. Here’s what patients can expect during a spinal tap:

1. Positioning: The patient is usually asked to lie on their side with knees pulled up towards the chest and chin tucked in. This position helps to open up the spaces between the vertebrae.
2. Sterilization: The skin area where the needle will be inserted is thoroughly cleaned to prevent infection.
3. Local anesthesia: A local anesthetic is administered to numb the area, minimizing discomfort during the procedure.
4. Needle insertion: A thin, hollow needle is carefully inserted between two vertebrae in the lower back. Patients may feel some pressure but should not experience severe pain.
5. CSF collection or medication administration: Depending on the purpose of the procedure, CSF may be collected for analysis, or medications may be injected.
6. Needle removal: Once the necessary samples are collected or medications administered, the needle is gently removed.
7. Dressing application: A small plaster or dressing is applied to the insertion site.

The entire procedure typically takes between 30 to 45 minutes. However, patients are usually required to remain lying down for at least an hour afterward for monitoring.

Post-Procedure Care and Recovery After a Spinal Tap

Recovery from a lumbar puncture is generally straightforward, but there are important considerations for patients to keep in mind:

• Rest: Patients are advised to rest and avoid strenuous activities for at least 24 hours following the procedure.
• Hydration: Drinking plenty of fluids helps replenish the CSF and may reduce the risk of headaches.
• Pain management: Over-the-counter pain relievers can help manage any discomfort or headaches.
• Caffeine intake: Some patients find that caffeinated beverages can help alleviate post-procedure headaches.
• Dressing care: The dressing can typically be removed the day after the procedure.

Most patients can return home the same day if they feel well enough, but should arrange for someone else to drive them.

When to Seek Medical Attention Post-Procedure

While complications are rare, patients should be aware of signs that warrant medical attention. These include:

• Severe or persistent headaches
• Nausea or vomiting
• High fever or chills
• Sensitivity to bright lights
• Prolonged back pain or swelling
• Fluid leakage from the insertion site

Prompt medical evaluation is crucial if any of these symptoms occur to prevent potential complications.

Understanding Lumbar Puncture Results and Their Implications

The results of a lumbar puncture can provide valuable insights into a patient’s health. Some preliminary findings may be available immediately after the procedure, while others require laboratory analysis that can take up to 48 hours or more.

Immediate Results

Certain aspects of the cerebrospinal fluid can be assessed immediately, such as:

• Appearance: Clear and colorless fluid is typically normal, while cloudy or bloody fluid may indicate an issue.
• Pressure: The opening pressure of the CSF can be measured during the procedure, providing information about intracranial pressure.

Laboratory Analysis

More detailed analysis of the CSF in the laboratory can reveal:

• Cell count and type: Elevated white blood cell counts may suggest infection or inflammation.
• Protein and glucose levels: Abnormalities in these levels can indicate various conditions.
• Presence of bacteria, viruses, or abnormal cells: These findings can help diagnose specific infections or cancers.

The healthcare provider will interpret these results in the context of the patient’s overall clinical picture to determine the appropriate diagnosis and treatment plan.

Potential Risks and Side Effects of Lumbar Puncture

While lumbar punctures are generally safe procedures, it’s important for patients to be aware of potential side effects and risks:

Common Side Effects

• Headache: This is the most common side effect, affecting up to 25% of patients. It typically resolves within a week.
• Back pain: Mild discomfort at the needle insertion site is normal and usually subsides within a few days.
• Bleeding: Minor bleeding at the puncture site may occur but is typically not concerning.

Rare Complications

Although uncommon, more serious complications can occur:

• Infection: There’s a small risk of introducing bacteria into the spinal canal, potentially leading to meningitis.
• Nerve damage: In rare cases, the needle may cause temporary or permanent nerve damage.
• Cerebral herniation: In patients with very high intracranial pressure, lumbar puncture can potentially lead to brain herniation, a serious complication.

Healthcare providers take numerous precautions to minimize these risks, and serious complications are exceptionally rare when the procedure is performed by experienced professionals.

Innovations and Advancements in Lumbar Puncture Techniques

Medical science continues to evolve, bringing improvements to lumbar puncture procedures. Some recent advancements include:

Atraumatic Needles

The development of atraumatic or “pencil-point” needles has significantly reduced the incidence of post-lumbar puncture headaches. These needles are designed to separate rather than cut through the fibers of the dura mater, resulting in a smaller hole that seals more quickly.

Image-Guided Procedures

For patients with challenging anatomy or those who have had difficulty with traditional lumbar punctures, image-guided techniques using fluoroscopy or ultrasound can improve accuracy and reduce complications.

Automated CSF Collection Systems

New automated systems for CSF collection are being developed to standardize the process and reduce the risk of contamination.

These advancements aim to make lumbar punctures more comfortable for patients and more efficient for healthcare providers, ultimately improving patient outcomes and experiences.

As medical technology continues to progress, we can expect further refinements in lumbar puncture techniques, potentially leading to even safer and more effective procedures in the future.

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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