Definition and Purpose
Lumbar puncture is a medical procedure that includes insertion of a needle into the subarachnoid space in the area of lumbar spine. This way the cerebrospinal liquid is obtained and can be further investigated. Basically the lumbar puncture is done in case that doctor suspect on meningitis. It can be also performed to confirm or rule out other conditions such as subarachnoid bleeding, hydrocephalus or benign intracranial hypertension.
The placement of the needle into the subarachnoid space is very convenient for administration of certain drugs such as chemotherapeutics in case of certain cancers. This pathway is also used when spinal anesthesia is administered.
In case of intracranial pressure whose precise cause has not been established lumbar puncture is a contraindication. So before each and every lumbar puncture it is best to perform CT scan of the brain and spine. Sometimes increased intracranial pressure can be reduced by lumbar puncture but the real cause of the increased pressure may be a tumor which can after the puncture lead to herniation of the brain in foramen magnum and instant death. In cases like this CT scan is perfect in modification of treatment options.
In coagulopathies, difficulties with breathing as well as in case of increased blood pressure this procedure in a contraindication. Even deformities of the back such as scoliosis and kyphosis can impede in the procedure unless the doctor is experienced enough.
Complications of Lumbar Puncture
The standard complication better to say consequence of lumbar puncture is headache. The headache can be effectively treated with analgesic medications together with intravenous fluids. The best prevention of this complication is maintained supine posture after the lumbar puncture. The patient is advised to stay in this position for approximately two hours. The patient should rest in bed and if the headache continues and is even more intensive in sitting position there may be additional complication - the leakage of the cerebrospinal fluid from the place of punction. This complication is treated by an epidural blood patch. This patch is actually patient's blood which is injected into the leaking spot. The blood coagulates and stops the bleeding.
One more complications results from the needle which can get in touch with the roots of spinal nerves and lead to abnormal sensations. These sensations affect lower extremities and are transient.
Severe complications such as epidural or spinal hemorrhage are not so common. The injury to the spinal nerves can lead to paraplegia in most extreme cases of possible complications.
In case there is slightest doubt about possible presence of epidural infection the intervention is not done. Even in cases of skin infection at the spot of puncture the intervention is avoided.