Spine puncture (lumbar) involves inserting a puncture needle between the vertebrae of the lumbar spine. Lumbar puncture is most often performed to collect the cerebrospinal fluid to diagnose, among others. causes of meningitis. Lumbar puncture may also be performed in order to administer anesthesia, e.g. before a caesarean section. Check what are the indications for a lumbar puncture and what complications may occur.

Spine puncture (lumbar puncture ) is a procedure that involves inserting a puncture needle with a stopper, the so-called a stylet (a metal rod that unblocks the needle) between the vertebrae of the lumbar spine (part of the back between the ribs and the pelvis) to the so-called subarachnoid space - a space filled with fluid produced in the brain (the so-called cerebrospinal fluid), mainly for its collection.

Spine puncture (lumbar) - indications for the test

Lumbar puncture and CSF collection are performed when a doctor suspects a nervous system disorder, such as meningitis (in which case the fluid is withdrawn to answer the question of what causes the inflammation) or multiple sclerosis .

An indication for lumbar puncture is also hydrocephalus in newborns. Suspicion of congenital metabolic disease and neoplastic disease is also an indication for the collection of cerebrospinal fluid. During puncture, excess cerebrospinal fluid can also be removed.

Lumbar puncture can also be performed for spinal anesthesia. The anesthetic is administered directly into the cerebrospinal fluid, for example in the case of a caesarean section. Moreover, thanks to the lumbar puncture, drugs can be administered, e.g. in the case of cancer (cytostatics are administered to the subarachnoid space) or infections of the nervous system (antibiotics are administered).

Spine puncture (lumbar) - contraindications

Lumbar puncture cannot be performed in patients with intracranial hypertension (increased pressure of the cerebrospinal fluid inside the skull) and cerebral edema. Contraindications are also purulent skin lesions in the lumbar region and serious blood coagulation disorders.

Spine puncture (lumbar) - course

The patient is placed on the table (likeclosest to its edge) on the left side, then tucks the legs up to the chest, and tilts the head up to the knees, so that the back is strongly arched. Adopting the correct position is most important as it not only allows the procedure to be performed efficiently, but also reduces the risk of complications. For the patient's comfort, a roller can be placed under his head and a pillow between the knees. The fluid can also be withdrawn while sitting. The patient then sits bent forward with his back to the doctor. He can hold a pillow or other support on his lap.

The doctor then decontaminates the area where the needle will be inserted and injects a local anesthetic.

Then he inserts a needle between two vertebrae into the space with the cerebrospinal fluid. After removing the cap from the needle, the cerebrospinal fluid flows out dropwise and collected into the test tubes. After removing the needle, a sterile dressing is placed over the puncture site.

Spine puncture (lumbar) - complications after the procedure

The most common complication is post-puncture syndrome, i.e. a headache after a lumbar puncture performed. Its characteristic feature is that it worsens within about 15 minutes after the patient takes a sitting or standing position, and decreases within 15 minutes after taking a lying position. Accompanying symptoms are nausea, stiff neck, hearing loss, tinnitus or photophobia. It disappears on its own within a week and leaves no lasting consequences.

The most serious complications after the procedure are purulent inflammation of the vertebrae, abscess formation, epidural empyema or purulent meningitis. They appear when the procedure has not been performed correctly, in non-sterile conditions.

There may be pain at the puncture site or bleeding from the site, as well as a hematoma.

In extreme cases, nerve paralysis may occur, caused by spinal cord damage. However, it is unlikely to happen if the nervous system and the spine are normal and the procedure has been performed correctly, i.e. the needle is inserted below the point where the spinal cord ends.

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