How to perform a cerebrospinal fluid puncture. Spinal puncture - preparation, technique. Why is a lumbar puncture performed?

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Lumbar puncture is a diagnostic or therapeutic procedure during which a puncture is made in the subarachnoid space of the spinal canal in the lumbar region. The manipulation is performed under local anesthesia, very rarely without it, and can be indicated for both children and adults.

Lumbar puncture can rightfully be considered one of the most informative methods for diagnosing the pathology of the central nervous system, meninges, liquor spaces. It has not only indications, but also serious contraindications, which must be carefully assessed by the attending physician who determines the feasibility of the procedure.

In recent decades, the number of lumbar punctures performed has decreased somewhat due to the widespread use of non-invasive diagnostic methods - computed tomography and magnetic resonance imaging, however, some diseases require qualitative and quantitative analysis of the cerebrospinal fluid, removal of its excess, and introduction of drugs into the subarachnoid space, which cannot be done without direct penetration into the liquor space.

The overwhelming majority of patients tolerate the puncture quite favorably, but there is still a risk of complications, so the attending physician must be extremely attentive and careful during the puncture, and the patient after it, informing specialists about all negative sensations.

Most often, a puncture of the spinal canal is performed by anesthesiologists, who can thus provide the collection of cerebrospinal fluid for examination, as well as pain relief for a variety of surgical interventions.

If the correct puncture technique is followed, it is almost painless for the patient, but it is capable of providing a sufficient amount of information in the diagnostic search and selection of adequate therapy.

When is a lumbar puncture necessary and why not?

lumbar puncture

Lumbar puncture is performed both for diagnostic purposes and for therapy, but always with the consent of the patient, except in cases where the latter is due serious condition cannot contact staff.

For diagnostics a spinal puncture is performed if it is necessary to examine the composition of the cerebrospinal fluid, determine the presence of microorganisms, fluid pressure and patency of the subarachnoid space.

Therapeutic puncture needed for the evacuation of excess cerebrospinal fluid or the introduction of antibiotics and chemotherapy drugs into the intrathecal space in case of neuroinfection or oncopathology.

The reasons for lumbar puncture are mandatory and relative, when the decision is made by the doctor based on a specific clinical situation. TO absolute indications include:

• Neuroinfections - meningitis, syphilitic lesions, brucellosis, encephalitis, arachnoiditis;
• Malignant tumors of the brain and its membranes, leukemia, when CT or MRI cannot make an accurate diagnosis;
• The need to clarify the causes of liquorrhea with the introduction of contrast or special dyes;
• Subarachnoid hemorrhage in cases where non-invasive diagnosis is not possible;
• Hydrocephalus and intracranial hypertension - to remove excess fluid;
• Diseases requiring the administration of antibiotics and antitumor agents directly under the membranes of the brain.

Among relative- pathology of the nervous system with demyelination (multiple sclerosis, for example), polyneuropathy, sepsis, unknown fever in young children, rheumatic and autoimmune diseases(lupus erythematosus), paraneoplastic syndrome. A special place is occupied by lumbar puncture in anesthesiology, where it serves as a method of delivering an anesthetic to the nerve roots to provide fairly deep anesthesia while maintaining the patient’s consciousness.

If there is reason to believe neuroinfection, then the cerebrospinal fluid obtained by puncture of the intrathecal space will be examined by bacteriologists, who will establish the nature of the microflora and its sensitivity to antibacterial agents. Targeted treatment significantly increases the patient's chances of recovery.

For hydrocephalus the only way delete excess liquid puncture is performed from the subarachnoid spaces and the ventricular system, and often patients feel relief almost immediately as soon as cerebrospinal fluid begins to flow through the needle.

If tumor cells are detected in the resulting liquid, the doctor has the opportunity to accurately determine the nature of the growing tumor, its sensitivity to cytostatics, and subsequent repeated punctures can become a way to administer drugs directly to the area of ​​tumor growth.

Lumbar puncture may not be performed on all patients. If there is a risk of harm to health or danger to life, then the manipulation will have to be abandoned. Thus, contraindications The following are considered to be punctures:

1. Cerebral edema with risk or signs of herniation of brain stem structures or cerebellum;
2. High intracranial hypertension, when removal of fluid can provoke dislocation and wedging of the brain stem;
3. Malignant neoplasms and other space-occupying processes in the cranial cavity, intracerebral abscesses;
4. Occlusive hydrocephalus;
5. Suspicion of dislocation of stem structures.

The conditions listed above are fraught with the descent of the stem structures to the foramen magnum with their wedging, compression of vital nerve centers, coma and death of the patient. The wider the needle and the more fluid removed, the higher the risk of life-threatening complications. If the puncture cannot be delayed, then the minimum possible volume of cerebrospinal fluid is removed, but if wedging occurs, a certain amount of liquid is reintroduced.

If the patient has suffered a severe traumatic brain injury, massive blood loss, has extensive injuries, or is in a state of shock, it is dangerous to perform a lumbar puncture.

Other obstacles to the procedure may include:

• Inflammatory pustular, eczematous skin changes at the point of the planned puncture;
• Pathology of hemostasis with increased bleeding;
• Taking anticoagulants and antiplatelet agents;
• Aneurysm of cerebral vessels with rupture and bleeding;
• Pregnancy.

These contraindications are considered relative, increasing the risk of complications, but in cases where puncture is vitally necessary, they can be neglected if maximum caution is observed.

Preparing for a lumbar puncture

Preparation for a planned lumbar puncture includes a comprehensive examination, psychological support, and adjustment of the list of medications taken. Before referring a patient for a lumbar puncture, he is prescribed other examinations, starting with routine blood and urine tests, coagulation tests and ending with a visit narrow specialists, CT, MRI, when necessary. This applies more to outpatients or patients whose lives are not in danger. Otherwise, the doctor will act quickly and based on the patient’s condition.

If the patient’s consciousness is not impaired, then he must inform the anesthesiologist about the medications he is constantly taking, the presence of allergies, and chronic somatic pathology. Women should make sure that there is no pregnancy, especially if they plan to administer radiocontrast agents, toxic antibiotics and cytostatics. All patients must sign written consent to the intervention.

Lumbar puncture is performed on an outpatient basis, when the patient himself comes for the procedure, or on an inpatient basis, if the patient is undergoing treatment or examination in a clinic. It is better not to eat or drink 12 hours before the scheduled procedure, and stop taking blood thinners two weeks later.

The puncture for children is carried out by consent and in the presence of the parent, who is simply obliged to support and calm the frightened and confused child. Usually in pediatrics, a puncture is performed under general intravenous anesthesia, which ensures calm and correct positioning of the child.

Important preparatory stage- psychological support for the patient, during which the doctor explains the essence of the procedure and argues in favor of its necessity. According to indications, sedatives are used. It is especially important to work with those people who are allergic to local anesthetics, because for health reasons they will undergo a puncture without pain relief.

Technique of the procedure

Before the manipulation, the operating room staff prepares a sterile set for lumbar puncture, including needles of different structures, but invariably sharp and thin, dressings, gloves, and tweezers. A prerequisite is the availability of drugs and devices to provide emergency assistance for acute allergic reactions and life-threatening conditions.

When performing a spinal puncture, the patient is placed on his side with his back to the surgeon or anesthesiologist or seated with his back bent as much as possible. To ensure maximum immobility of the subject, an assistant helps to hold him; if the patient is a child, then the parents. Depending on the pose, the technique of performing the manipulation varies.

If a puncture is planned with the patient lying down, then he will be asked to take the so-called fetal position, similar to how a growing fetus is located in the uterus: the back is bent to the limit, the bent legs are brought to the abdominal wall, the head is pressed to the chest. In this position, the maximum divergence of the vertebral processes is achieved with the expansion of the distances between them in the lumbar region.

The sitting position is quite comfortable for both the anesthesiologist and the patient, who sits on the edge of the couch or table with the lower limbs mounted on a stand, leans forward, crosses his arms over his chest or leans them on the operating table. To increase the space between the vertebrae, the patient is asked to arch his back as much as possible.

The supine position is preferable for lumbar puncture in women in labor, severe pain after injuries, in patients with whom it is not possible to establish contact, and the sitting position for high degrees obesity.

The algorithm for performing a lumbar puncture includes:

1. Preparing the necessary instruments, disinfecting gloves, laying or sitting the patient, treating the puncture site (twice with iodine and three times with alcohol);
2. Determination of the puncture point, administration of local anesthetics;
3. The actual puncture of the subarachnoid space with a special needle with a mandrel, removed only when the needle has precisely taken the correct position under the membrane of the brain;
4. Extracting cerebrospinal fluid or administering medications;
5. Removing the needle only after returning the mandrel to its original position inside it.

puncture point

The puncture point is determined by the anesthesiologist or surgeon. In adults, it lies between the third and fourth lumbar vertebrae, in children - below, between the fourth and fifth, but always below the third, at the level of which the spinal cord is located. These points are recognized as the safest, because the spinal cord ends higher, so the risk of damage to it is minimal if the correct procedure algorithm is followed.

When the doctor determines and marks the puncture site, the skin is treated three times with an antiseptic, and then soft fabrics anesthetized with a solution for local anesthesia- novocaine, lidocaine in a volume of up to 10 ml. The patient feels virtually no discomfort due to analgesia. For young patients, the puncture is performed under general anesthesia.

The list of instruments for spinal anesthesia includes special needles with a mandrel, which prevents the opening of the needle and complications. The puncture is carried out between the spinous processes, carefully and smoothly so as not to damage the nerves and blood vessels. The needle is inserted exactly in the middle, parallel to the direction of the spinous processes.

puncture point in a child

As the needle moves, it pierces the soft tissues of the back, ligaments and hard shell spinal cord. When it penetrates the subarachnoid space, it seems to fall into a void, which the surgeon feels (at a depth of up to 7 cm in adults and about two cm in children). If this does not happen, the needle could rest against the bony process of the vertebra or may not be inserted deep enough. To determine the position of the needle, the doctor may remove the mandrin. If fluid is released, then the needle is in the subarachnoid space.

During a diagnostic puncture, only a few milliliters of cerebrospinal fluid are removed, for hydrocephalus - up to 120 ml, and then the mandrin is returned to its place and the needle is withdrawn. The puncture area is lubricated with an antiseptic, and a sterile bandage is applied. For several hours after the procedure, you will need to lie on your stomach, keeping complete rest.

Most patients undergoing lumbar puncture are afraid of pain, which is indeed possible, but only at the moment of the first injection, through which analgesia is produced. As novocaine or lidocaine permeates the tissue, numbness or bloating is felt, and then sensitivity is blocked by the anesthetic, and further actions doctors no longer cause any pain.

If the needle accidentally touches a nerve root, sharp, sudden pain may occur in one of the lower limbs or perineal area. This phenomenon is not dangerous, but the patient should immediately report his feelings to the doctor so that he can correct the course of the needle.

Video: lumbar puncture technique

Consequences of puncture

Upon completion of the lumbar puncture, it is impossible to get up and move independently; the patient is transported lying down to the ward, where he will spend several more hours lying on his stomach without a pillow. Children of the first year of life are placed on their backs with a cushion under their buttocks. Every 15 minutes, an anesthesiologist or surgeon enters the room and notes the heart rhythm, pressure, and body temperature.

For the first 2-3 days after the puncture, bed rest is prescribed, which is canceled only if the patient’s condition is satisfactory and full confidence in the absence of complications. The most common side effect of the procedure performed - headache, which often requires the use of analgesics. Cranialgia is not life-threatening; it goes away within a week at most, but the attending physician should be informed of such a symptom.

Spinal tap- This is an invasive intervention that can cause complications. According to statistics, consequences from the procedure may occur in 0.3% of patients, and most often they are associated with an insufficiently adequate assessment of the need and obstacles, violation of the procedure technique, and the use of wide needles.

Complications of puncture are:

• The phenomena of meningism - develop due to irritation of the membranes of the brain, manifested by symptoms of their inflammation;
• Infectious processes (arachnoiditis, meningitis) if precautions are not observed during puncture;
• Cranialgia;
• Trauma to the spinal roots with severe and persistent pain, usually due to technical errors;
• Bleeding due to hemocoagulation disorders or taking certain medications;
• Wedging of stem structures due to intracranial hypertension or multiple punctures;
• Needle injury intervertebral disc with the development of hernial protrusion;
• Myelitis, radiculitis, arachnoiditis with the administration of antibacterial drugs, cytostatics, analgesics, radiocontrast agents (manifested by excess cellularity and an increase in the protein content in the cerebrospinal fluid in the absence of microbes and normal sugar concentration).

In general, lumbar puncture can be considered a safe method of diagnosis and treatment, but only if the puncture algorithm is followed and its feasibility is adequately assessed. Patients should not be afraid of manipulation, because its result can answer many complex questions regarding the nature of the pathology, the possibility of treatment and prognosis in the future.

Video: Lumbar puncture

A lumbar puncture is a procedure in which cerebrospinal fluid is removed from the spinal canal for further examination.

The action is used mainly to confirm or exclude inflammatory diseases of the central nervous system, spinal cord and spinal membrane. The procedure is also used in the diagnosis of bleeding in the brain.

A spinal tap is performed in the lumbar region, in a place where the spinal cord no longer reaches. There is therefore no risk of injury or damage.

The procedure is followed by 24 hours of bed rest as a preventive measure aimed at preventing headaches.

From the history of spinal puncture

Historically, the first documented sampling of cerebrospinal fluid dates back to the end of the 19th century. A qualitative breakthrough in the development of this method occurred in the 50s of the 20th century, when lumbar puncture was performed in almost every suspected neurological disease.

Currently, the procedure is one of the most frequently performed minimally invasive ones. We can say that in the diagnosis of some diseases it is a necessary condition (bleeding into the spinal canal,).

Scope of application

All indications for performing lumbar puncture are divided into absolute and relative.

Absolute readings

Based on the medical history and clinical picture (symptoms), as well as the results of the examinations, the doctor - neurologist, surgeon or therapist - will recommend or perform a spinal puncture.

The method is used primarily for the diagnosis of inflammatory or degenerative diseases of the brain, spinal cord membrane, medulla itself and nerve roots, detection of bleeding in the spinal canal, confirmation or exclusion of the presence cancer cells in the cerebrospinal fluid.

Cerebrospinal fluid puncture can also be performed for therapeutic (medicinal) purposes, due to its ability to reduce high pressure in the meninges by withdrawing fluid or injecting drugs into the cerebrospinal fluid.

Repeat sampling is used to monitor disease progression or treatment effectiveness.

So, lumbar puncture is used for the following purposes:

• diagnostics ( , );
• confirmation or exclusion of bleeding in the central nervous system;
• diagnosis of demyelinating diseases ();
• determination of primary CNS tumors and metastases.

Relative readings

Less common indications for lumbar puncture include diagnosing dementia (,), assessing the extent of CNS tissue damage and determining prognosis after post-global hypoxic injury (eg, after cardiopulmonary resuscitation), and.

When is the procedure contraindicated?

Contraindications to fluid collection:

• high intracranial pressure (more than 220 mm H2O);
• confirmed intracranial expansive processes;
• infection at the injection site;
• sepsis;
• bleeding;
• vertebral deformities (scoliosis, kyphosis, spinal adhesions).

Preparation and technique for lumbar puncture

During a spinal tap, the patient does not need any preparation. The procedure takes only a few minutes. After the examination

Spinal puncture needle

24 hours of strict bed rest are required to prevent complications after dural puncture.

If we are talking about an outpatient examination, subsequent hospitalization should be taken into account. More often, however, lumbar puncture is performed in the context of hospitalization.

A spinal puncture is performed on an outpatient basis, but if necessary, the specialist will only need the patient’s hospital bed. The procedure does not require any special equipment, however, it is necessary that all equipment is sterile!

The doctor uses a special puncture needle, which is hollow, but when inserted into the patient’s body, it contains a so-called metal mandrel, which is a thin fiber. After inserting the needle into the intended place, the fiber is removed, creating space for the selected fluid or administration of the drug.

The patient sits or lies with his back to the doctor; the back is bent, causing the vertebrae to separate from each other. This is necessary so that the needle can easily enter the spinal canal.

Collection occurs in the lumbar region, namely in midline between the spinous processes of the 3rd and 4th lumbar vertebrae or the 4th and 5th vertebrae.

First of all, the injection site is determined, then it is disinfected and anesthetized. The actual injection is usually painless, but may be a little uncomfortable and the patient will usually feel pressure.

After correct administration The mandrel is removed from the needle and the pressure of the cerebrospinal fluid in the spinal canal is measured. The doctor then collects the fluid into a laboratory tube; it flows mostly on its own. Already at this stage, a specialist can evaluate the visual aspect of the liquor, especially its color and impurities.

After collection, the pressure is measured again using a pressure gauge and the needle is removed. The injection site is then closed and the patient assumes a horizontal position in bed.

The cerebrospinal fluid sample is sent to a laboratory where it undergoes biochemical, microbiological and immunological analysis.

The first hours after the procedure

After the procedure, the patient must remain absolutely at rest for 24 hours, being in a horizontal position and remembering to consume a sufficient amount of fluid.

You should lie down all day, even without raising your head, because this is the only way to prevent very severe headaches that arise as a result of the intervention.

CSF examination

Statin tests:

• assessment of the appearance of CSF before and after centrifugation;
• determination of the number of nucleated cells and red blood cells in a volumetric unit;
• screening tests for protein and hemoglobin;
• total protein – quantitatively;
• glucose and lactate;
• spectrometry for suspected bleeding into the cerebrospinal fluid tract.

Basic immunochemical tests:

• albumin, IgG, IgM (quantitative);
• oligoclonal IgG.

CSF and serum are always examined at the same time!

Special expertise

An additional basic immunological panel of IgA (quantitatively), free light chain (quantitatively and/or electrophoretically), or other plasma proteins (components C3, C4, transthyretin, transferrin and many others, the value of which in diagnosis) are examined neurological diseases not yet fully proven).

Triggers of CNS tissue damage (partially specific to a particular type of damage at the level of individual cell populations):

Auxiliary Value Research:

• Cl, Na, K ions;
• enzymes: LD and isoenzymes LD, CK, CK-BB;
• classical electrophoresis of cerebrospinal fluid protein.

Diagnosis of liquorrhea

CSF leak = leakage of cerebrospinal fluid in the meninges, usually after neurosurgery or trauma; (cerebrospinal fluid leakage from the nose = rhinorrhea; liquorrhea from the ears = otorrhea):

• beta2-transferrin (asialotransferrin, i.e. transferrin in which there are no sialic acid residues) - electrophoretic map; it is also necessary to examine the serum;
• beta trace protein (prostaglandin D synthase - quantitative);
• indicative (unreliable) statin tests: glucose, potassium, total protein.

What does blood in the cerebrospinal fluid mean?

Pink or red color of the cerebrospinal fluid indicates the presence of blood impurities originating from damaged blood vessels or caused by bleeding from subcutaneous blood vessels in the injection area (= artificial bleeding). In this case, a test of 3 test tubes is carried out - the liquid is collected in 3 test tubes and in the 3rd it should be transparent and colorless.

If even in the 3rd test tube there is a bloody admixture in the liquid, we can talk about.

What should a patient expect after the procedure?

Complications after lumbar puncture are rare, but they can still be:

• headache due to changes in pressure (so-called post-puncture syndrome);
• paresthesia of the lower extremities;
• swelling at the injection site;
• bleeding from the injection site;
• disorders of consciousness;
• migraine;
• nausea;
• urination disorder.

Lumbar puncture is the process of collecting cerebrospinal fluid from the spinal canal, followed by its examination. This procedure may be required to diagnose a number of diseases of the nervous system or for therapeutic purposes. A lumbar puncture may be prescribed for traumatic brain injuries or bleeding. To avoid headaches after the procedure, the patient is advised to remain in bed for 24 hours.

A spinal tap is performed to identify infections in the cerebrospinal fluid and measure its pressure. Another of its purposes is the selection of cerebrospinal fluid from the spinal canal in case of its excess, the administration of medications (Diclofenac, antibiotics or chemotherapy drugs). Indications for lumbar puncture can be divided into absolute and relative.

Absolute indications indicate those conditions in which lumbar puncture is mandatory. Among them are the following:

1. Suspicion of damage to the central nervous system by infection (meningitis, encephalitis, etc.).
2. The presence of malignant tumors in the brain or its membranes.

Why is a lumbar puncture done? Allergist-immunologist Ermakov Georgy Aleksandrovich will answer the question:

1. Diagnosis of liquorrhea. To do this, contrast agents are injected into the spinal canal.
2. , which occurred under the arachnoid membrane.

Relative indications for lumbar puncture include cases when the decision on the advisability of the procedure is made by the attending physician:

• Septic vascular embolism.
• At .
• Systemic lupus erythematosus and other connective tissue pathologies.
• For inflammatory polyneuropathy.
• Fever of unknown origin in a child of the first years of life.

Contraindications for carrying out

There are situations when performing a lumbar puncture can be dangerous for the patient or even threaten his life. In such cases, it is strictly prohibited. Contraindications for the procedure include:

1. Occlusive hydrocephalus.

1. Diagnosis of a large tumor in the brain.
2. High intracranial pressure.

When such pathologies are identified, it is prohibited to perform a lumbar puncture, as this can provoke axial herniation, when part of the brain can descend into the foramen magnum, causing disruption in the functioning of the vital centers located here. The risk of such herniation increases significantly if a thick spinal puncture needle is used or a large volume of fluid is collected.

If the doctor believes that the procedure is necessary for a particular patient, then a minimum amount of cerebrospinal fluid is allowed to be removed, and if signs of wedging occur, it is necessary to urgently return the previously extracted fluid to the spinal canal.

Other contraindications to lumbar puncture include:

• Purulent rashes in the lumbar region.
• Blood clotting disorders.
• Hemorrhages in the brain or spinal cord due to a ruptured aneurysm.

• Pregnancy period.
• Treatment with drugs that can thin the blood.
• Blockade of the subarachnoid space.

Doctors call these contraindications relative, and a lumbar puncture can be performed if there are vital signs. important indications. It is important to consider all possible risks and complications that the procedure may cause.

Possible complications

As a rule, complications after a lumbar puncture are possible only if the execution algorithm was violated. This may result in the following consequences:

1. Postpuncture syndrome. As a result of this pathology, epithelial cells enter the lining of the spinal cord. There is a displacement or expansion of blood vessels in the brain.
2. Hemorrhagic complications (intracerebral or intracranial hematoma). As a result of violation of the procedure, bleeding may occur.
3. A teratogenic factor is the occurrence of an epidermoid tumor in the spinal canal due to the displacement of skin elements into its cavity. As a result of the formation of a tumor, the patient experiences aching pain in the lower back and lower extremities, which can intensify over time. The reason for this factor is the absence or incorrect placement of the stylet in the puncture needle.

More information about complications after puncture:

1. Injury to nerve endings, intervertebral discs or infection.
2. Liquorodynamic complication. The appearance of a tumor in the spinal canal provokes high pressure of the cerebrospinal fluid in it, which during a lumbar puncture can cause neurological deficit and acute pain.
3. Changes in the composition of cerebrospinal fluid. When introducing air, drugs or other drugs into the subarachnoid area foreign bodies, a meningeal reaction may occur.
4. Other complications. After a lumbar puncture, the patient may feel dizzy or nauseous. These symptoms usually go away quickly. If the spinal puncture was performed incorrectly, then radiculitis, myelitis or.

Carrying out a puncture

A procedure such as cerebrospinal fluid puncture does not require special preparation and is performed within a few minutes. To avoid various complications after the procedure, the patient is advised to remain in bed for the first 24 hours.

Spinal puncture must be performed in a laboratory setting. No special equipment is needed to perform a lumbar puncture, but everything must be sterile.

Lumbar puncture technique:

• The puncture site is treated with an antiseptic, alcohol and iodine solution.
• Sterile napkins are placed around the area where the puncture will be made.
• The patient lies on his side with his knees bent. The head is pressed to the chest. Less commonly, a spinal tap is performed in a sitting position with a bent back. When performing a lumbar puncture in children, an assistant must hold the baby in the correct position.
• The location of the needle insertion is determined (in newborns and small children - between the 4th and 5th lumbar vertebrae, in adults - between the 2nd and 3rd).

Algorithm for performing lumbar puncture

• An anesthetic substance (Lidocaine, Novocaine) is injected into this place.
• After a few minutes, the needle is inserted. If everything is done correctly, then, based on patient reviews, at the moment of insertion the needle is felt to sink into the meninges.
• The stylet is removed from the needle, after which the movement of the cerebrospinal fluid begins.
• Fluid pressure is measured using a pressure gauge.
• The needle is removed and a sterile dressing is applied to the insertion site.

Cerebrospinal fluid examination

Typically, cerebrospinal fluid collected during lumbar puncture is subject to general, microbiological and biochemical examination.

Carrying out a general analysis, the density of the cerebrospinal fluid, its color, acidity level are assessed, the number of cells in 1 μl and the presence of protein in it are determined. If necessary, the laboratory technician will check for the presence of epidermal cells, arachnoendothelium, or tumor components in the liquid.

The normal density of the liquid is 1.005-1.008. If it is elevated, this may indicate the presence of an inflammatory process. If the density decreases, we can talk about excess liquid.

The normal acidity level is considered to be 7.35-7.8. Its increase indicates paralysis, epilepsy or neurosyphilis. A decrease indicates the development of encephalitis or meningitis.

In normal condition, the cerebrospinal fluid should be transparent. A dark shade indicates the development of jaundice or the spread of melanoma metastases. If it has a yellowish tint, this indicates hemorrhage in the arachnoid space, high protein or bilirubin.

The protein norm is considered to be no higher than 0.45 g/l. Its level can increase significantly with hydrocephalus, neoplasms or inflammatory processes and other pathologies of the central nervous system.

During a biochemical study, the laboratory technician will determine the level of certain substances:

1. Glucose (normal 2.2-3.9 mmol/l). During the development of encephalitis or meningitis, its level decreases. And with a stroke it increases.
2. Lactate (normal 1.1-2.4 mmol/l). An increase in this substance indicates the presence of bacterial meningitis, ischemia, hydrocephalus or brain abscess. Lactate levels decrease as a result of meningitis caused by viruses.
3. Chlorides (normal 118-132 mol/l). With echinococcosis, or a neoplasm in it, the concentration of chlorides increases, and with brucellosis or neurosyphilis it decreases.

During the microbiological analysis, the liquor is stained depending on the expected type of pathogen and inoculated on a nutrient medium. This way, a physician can identify a specific pathogen and determine its sensitivity to the effects of drugs.

Sometimes after a lumbar puncture, blood can be detected in the cerebrospinal fluid. There are 2 main reasons for its presence: mechanical damage to the vessel during the procedure or hemorrhage into the arachnoid membrane. To determine the exact cause, the collected liquid is divided into 3 tubes. If the liquid turns out to be uniformly colored everywhere, then we can talk about a hemorrhage that has occurred. If the cerebrospinal fluid has different degrees of staining in different tubes, then most likely the vessel was damaged during the lumbar puncture.

The color of cerebrospinal fluid is normal and in some pathological conditions. A - normal; B — turbidity of the cerebrospinal fluid due to the admixture of a large number of formed elements (meningitis); C, D — blood in the cerebrospinal fluid (subarachnoid hemorrhage, trauma); D - blood entering the cerebrospinal fluid during a puncture (“travel blood”) - after centrifugation it becomes transparent, formed elements settle at the bottom of the tube; E, I - xanthochromia of the cerebrospinal fluid as a result of hemolysis of erythrocytes; F - greenish color of the cerebrospinal fluid when purulent meningitis; H - formation of a fibrin film with a high fibrinogen content

The result of a lumbar puncture may be influenced by the following factors:

• Incorrect actions of doctors or the patient’s restless position.
• Presence of dehydration.
• Bleeding that occurs into the cerebrospinal cavity.
• Obesity.
• Severe forms of arthritis.
• Previously undergone surgical interventions on the spinal region.

The cost of a lumbar puncture may vary depending on the chosen medical institution, the complexity and nature of the cerebrospinal fluid tests. The average price can vary from 1500 to 5500 rubles.

Lumbar puncture is a very informative diagnostic procedure that can also be used for therapeutic purposes. Just like other research methods, it has its own indications and contraindications. If the procedure technique is violated, the patient may experience complications and other negative reactions, so it should only be performed by a qualified physician.

Only the attending physician, who will assess all possible risks, can decide on the advisability of performing a spinal puncture. In most cases, the procedure is well tolerated, but sometimes the patient may experience complications. If any unpleasant symptoms appear after the puncture, it is important for the patient to consult a doctor.

A lumbar puncture, or lumbar puncture, is a diagnostic or therapeutic procedure performed on an outpatient basis using local anesthesia. The purpose of a diagnostic lumbar puncture is to obtain a sample of cerebrospinal fluid, laboratory test which will confirm or exclude suspicion of any diagnosis.

For therapeutic purposes, sampling a certain volume of cerebrospinal fluid is most often used to reduce intracranial pressure or administer medications.

Some anatomical characteristics of the structure of the spinal cord and its membranes

The spinal cord is the main channel for transmitting information connecting the brain and the peripheral nervous system, innervating all organs and tissues located below the base of the skull. The organ is enclosed in the spinal canal, which runs inside the bony base of the vertebrae. A characteristic feature of the spinal cord is that its length is much shorter spinal column. The spinal cord originates as a continuation of the medulla oblongata and reaches the second lumbar vertebra, where it ends in the form of a fibrous extension called the filum terminale or cauda equina.

The total length of the spinal cord in an adult, regardless of his height, is:

• for men - 45 cm;
• for women - about 43 cm.

In the region of the cervical and lumbar spine, the spinal cord forms characteristic thickenings, from which large numbers of nerve plexuses arise, causing separate innervation of the thoracic and pelvic limbs, respectively.

Being in the lumen of the spinal canal, the spinal cord is sufficiently protected from external physical influences by the thickness of the bones of the spinal column. In addition, throughout the entire length of the organ, it is enveloped in three successive layers of tissue, providing its additional safety and functional tasks.

• Dura mater is the outer layer lining the spinal canal, to which it is loosely adjacent - a cavity is formed between the membrane and the walls of the canal, called the epidural space. The epidural space is mostly filled with adipose tissue and is penetrated by a wide network of blood vessels, which provides the shock-absorbing and trophic needs of nearby tissues, including the spinal cord.
• Arachnoid or arachnoid medulla is the middle layer covering the spinal cord.
• Pia mater. Between the arachnoid and pia mater is formed the so-called subarachnoid or subarachnoid space, which is filled with 120-140 ml of cerebrospinal fluid(cerebrospinal fluid of the subarachnoid space) in an adult, it is abundantly saturated with a network of small blood vessels. It is worth noting that the subarachnoid space is directly connected to the same space in the skull, which ensures a constant exchange of fluid between the cranial and spinal cavities, the boundary between which is considered to be the opening of the fourth ventricle of the brain.
• At the end of the spinal cord nerve roots"Cauda equina" float freely in the cerebrospinal fluid.

Biologically, the arachnoid membrane is represented by a network of interwoven threads of connective tissue that looks like a spider’s web, which explains its name.

It is extremely rare to combine the arachnoid and pia mater, giving them a common name leptomeninges, and the dura mater is isolated as a separate structure, pachymeninx.

In what cases is it necessary to perform a lumbar puncture?

Lumbar puncture is performed from the lumen of the subarachnoid space between the dura mater and arachnoid membranes spinal cord in the lumbar region of the spinal column, where the spinal cord completes its length. This area helps reduce the risks associated with physical damage to the spinal cord.

Taking cerebrospinal fluid from diagnostic indications is carried out due to the exclusion of infectious, inflammatory and tumor pathologies that can have a detrimental effect on the central nervous system.

More often the reason for the sampling may be a suspicion of meningitis , for the diagnosis of which there is no more reliable method than laboratory testing of cerebrospinal fluid.

Large concentrations of colonies of trypanosomes (microorganisms) causing a rather rare but very severe infectious disease of humans, known as sleeping sickness or African trypanosomiasis , is contained precisely in the cerebrospinal fluid.

In newborns, a lumbar puncture is often performed to exclude complications such as meningisms, when fever of unspecified etiology is detected and genesis.

In addition, at any age, a number of diseases can be confirmed or excluded using laboratory testing of cerebrospinal fluid.

• Subarachnoid hemorrhage.
• Multiple sclerosis.
• Hydrocephalus.
• Benign intracranial hypertension and other non-contagious pathologies.

One of the most common indications for a spinal puncture is the suspicion of malignant oncogenesis in the central nervous system. Carcinomatous meningitis and medulloblastomas often cause the presence of free-floating metastatic formations in the spinal cerebrospinal fluid.

Therapeutic spectrum There are several indications for lumbar puncture at same. Antibiotics are often injected into the lumen of the subarachnoid space for infectious pathologies in order to quickly deliver the drug to the pathological focus and accumulate it in sufficient concentration. In some malignant oncological pathologies of the brain and spinal cord, cerebrospinal fluid is used as a delivery system to provide the necessary dosages of chemotherapy around the tumor.

In addition, a puncture is used when a surgical intervention in the area of ​​the spinal column.

Pumping out the required amount of cerebrospinal fluid is often indicated with increased intracranial pressure, usually arising as a result of cryptococcal meningitis or hydrocephalus with normal intracranial pressure.

Comment by Anatoly Vladimirovich Malyshev, neurosurgeon:

Lumbar puncture is of a diagnostic and therapeutic nature.

In both adults and children, it should be performed by a doctor who has sufficient experience in performing this manipulation.
Even with such a harmless, at first glance, manipulation, you can leave the patient deeply disabled.

The technique of implementation is, as a rule, standard, but in obese patients it is difficult to find landmarks (the so-called Michaelis diamond comes to the rescue).

Contraindications for lumbar puncture

This pathological condition is characterized by individual displacements of some cerebral areas relative to their normal location. This phenomenon occurs due to increased intracranial pressure, when physical forces stimulate invagination, herniation or pinching of the brain parenchyma and, as a consequence, its pathological contact with the anatomical features of the cranial bones. Most often, the effects of the formation of hernial strangulations of the brain into separate cavities filled with cerebrospinal fluid, which physiologically serve as a cerebrospinal fluid reservoir, are observed.

The collection of cerebrospinal fluid helps to reduce intracranial pressure, and this situation can unpredictably affect the displacement of the brain, which in the vast majority of cases leads to sudden death.

Thus, lumbar puncture as a therapeutic effect for increased intracranial pressure is performed with great caution, having first completely excluded phenomenon of cerebral dislocation.

Technique for performing cerebrospinal fluid puncture

The technique of puncture is not particularly difficult, however, specialists who have experience in puncture or have undergone training on artificial emulators are allowed to perform the procedure.

The puncture is performed on an outpatient basis. Conducting it at home is strictly prohibited due to the lack of resuscitation capabilities in case of an unsuccessful puncture.

Before the puncture, no additional preparation of the patient is required, except psychological, since the very fact of a deep puncture in the spine is quite difficult for emotional perception.

There is a certain procedure for carrying out the procedure.

• The patient is placed in the lateral or sitting position.
• Regardless of the position the back should be bent as much as possible, which is ensured by tightly pressing both knees to the stomach and clasping them with your hands. This position helps to create the largest possible space for advancing the needle, eliminating the risk of it being pinched by the vertebral bodies.
• The point of insertion of the needle is the intervertebral space between the third and fourth or second and third lumbar vertebrae - the place where the length of the spinal cord ends and the extension for the cauda equina is formed. This puncture site is typical for adults, but for children, due to the insufficient length of the spinal column, the puncture is performed under the third lumbar vertebra.
• General anesthesia is not required. Often use a 1-2% solution of novocaine for the purpose of local anesthesia, when the drug is administered in layers, approximately every 1-2 mm of the needle insertion depth, squeezing out a small amount of solution.
• Bir's needle resembles a classic injection needle, but much larger in length and diameter of the internal hole. The needle is inserted strictly along the midline of the spinal column between the spinous processes of these vertebrae until a feeling of failure is felt at a depth of about 4-7 cm in adults and 2 cm in children, which causes penetration into the subarachnoid space.
• The cerebrospinal fluid is under pressure, which is additionally ensured by the position of the back during puncture, so the use of suction manipulations is not required.
• Before and after the puncture, its place is treated antiseptics, and upon completion is sealed with a sterile adhesive tape.
• The patient is asked to lie on his stomach and try to remain as static as possible for 2 hours, which will ensure uniform distribution of cerebrospinal fluid to replace the withdrawn fluid. When administering drugs, a state of rest will ensure synchronization of pressure in the subarachnoid space throughout its cavity, as well as uniform exposure to the drug, which reduces the level of side effects after puncture.

Possible consequences and complications of the procedure

Considering such active interference in the functionality of the cerebrospinal fluid, spinal cord, as well as its direct anatomical and physiological contact with the brain, Lumbar puncture can cause a significant number of side effects and complications.

Very severe pain in the lumbar region, accompanied by nausea- a fairly common occurrence after puncture, which is explained specific effects of analgesics that enter the cerebrospinal fluid and directly affect the neurons of the spinal cord and brain. Intravenous administration caffeine often helps suppress this side effect, but the drug is used in the absence of contraindications to it, of which there are quite a few.

Contact of the needle with the root of the spinal nerve often causes a feeling of loss of motor functions of the lower extremities and quite severe pain, about which the patient should be warned in advance. This phenomenon is temporary and, provided there is no damage to the roots, does not cause harm.

Headache- a constant companion of the patient after lumbar puncture for the next 5-7 days. This effect is caused by a decrease or increase in the level of intracranial pressure due to corresponding changes in the volume of cerebrospinal fluid.

Headache can accompany the patient for a much longer period and are characterized as painful if the puncture was performed in a sitting position. The reason for the phenomenon lies in the excessive release of cerebrospinal fluid through the puncture channel into the ligamentous tissue or under the skin. The puncture channel remains open for quite a long time, since the cerebrospinal fluid that has penetrated into its lumen does not contain thickening elements that contribute to clogging the hole. In some cases, experienced specialists, after obtaining the required amount of cerebrospinal fluid, during withdrawal of the needle, inject small amounts of fresh blood from the patient, taken from a vein in advance. This method allows you to block the canal, but is somewhat dangerous, because blood clots should not get into the subarachnoid space.

Serious complications due to correctly performed lumbar puncture, they are extremely rare. But they exist.

• Spinal or epidural bleeding.
• Arachnoiditis.
• Injury to the parenchyma of the spinal cord or its roots, which can lead to loss of sensitivity in the pelvic area, disturbances in urination and defecation, as well as partial or complete paralysis.

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Spinal cord puncture

Spinal cord puncture (lumbar puncture) is a type of diagnosis that is quite complex. The procedure removes a small amount of cerebrospinal fluid or injects drugs and other substances into the lumbar spinal canal.

IN this process The spinal cord is not directly affected. The risk that arises during puncture contributes to the rare use of the method exclusively in a hospital setting.

• fence small quantity cerebrospinal fluid (cerebrospinal fluid). Subsequently, their histology is carried out;
• measuring the pressure of cerebrospinal fluid in the spinal canal;
• removal of excess cerebrospinal fluid;
• administration of drugs into the spinal canal;
• relief of difficult labor in order to prevent painful shock, as well as as anesthesia before surgery;
• determining the nature of the stroke;
• isolation of tumor markers;
• performing cisternography and myelography.

• bacterial, fungal and viral infections (meningitis, encephalitis, syphilis, arachnoiditis);
• subarachnoid bleeding (bleeding in the brain);
• malignant tumors of the brain and spinal cord;
• inflammatory conditions of the nervous system (Guillain-Barré syndrome, multiple sclerosis);
• autoimmune and dystrophic processes.

• inflammatory polyneuropathy;
• fever of unknown pathogenesis;
• demyelinating diseases (multiple sclerosis);
• systemic connective tissue diseases.

Preparatory stage

1. Registration of written consent for the manipulation.
2. Taking blood tests to evaluate blood clotting, as well as the functioning of the kidneys and liver.
3. Hydrocephalus and some other diseases require computed tomography and MRI of the brain.
4. Collection of information on the medical history, recent and chronic pathological processes.

Technique of the procedure

• adherence to bed rest for 3 to 5 days as recommended by a doctor;
• keeping the body in a horizontal position for at least three hours;
• getting rid of physical activity.

• axial wedging;
• meningism (symptoms of meningitis occur in the absence of an inflammatory process);
• infectious diseases of the central nervous system;
• severe headache, nausea, vomiting, dizziness. Your head may hurt for several days;
• damage to the spinal cord roots;
• bleeding;
• intervertebral hernia;
• epidermoid cyst;
• meningeal reaction.

• Do you have a sedentary lifestyle?
• You can’t boast of a royal posture and try to hide your stoop under clothes?
• It seems to you that this will soon go away on its own, but the pain only gets worse.
• Many methods have been tried, but nothing helps.
• And now you are ready to take advantage of any opportunity that will give you the long-awaited well-being!

Spinal tap

Spinal cord puncture. Such a terrible phrase can often be heard at a doctor’s appointment, and it becomes even scarier when this procedure concerns you specifically. Why do doctors puncture the spinal cord? Is such manipulation dangerous? What information can be obtained from this study?

The first thing you need to understand when it comes to spinal cord puncture (which is what patients most often call this procedure), it does not mean a puncture of the tissue of the central nervous system organ itself, but only the collection of a small amount of cerebrospinal fluid, which washes the spinal cord and brain . Such manipulation in medicine is called a spinal, or lumbar, puncture.

Why is a spinal cord puncture performed? There can be three purposes for such manipulation – diagnostic, analgesic and therapeutic. In most cases, a lumbar puncture of the spine is done to determine the composition of the cerebrospinal fluid and the pressure inside the spinal canal, which indirectly reflects pathological processes occurring in the brain and spinal cord. But specialists can perform a spinal cord puncture for therapeutic purposes, for example, to administer medications into the subarachnoid space to quickly reduce spinal pressure. Also, one should not forget about such an anesthesia method as spinal anesthesia, when anesthetics are injected into the spinal canal. This makes it possible to perform a large number of surgical interventions without the use of general anesthesia.

Considering that in most cases, spinal cord puncture is prescribed for diagnostic purposes, this type of research will be discussed in this article.

Why is a puncture taken?

A lumbar puncture is taken to examine the cerebrospinal fluid, which can help diagnose some diseases of the brain and spinal cord. Most often, such manipulation is prescribed for suspected:

• infections of the central nervous system (meningitis, encephalitis, myelitis, arachnoiditis) of a viral, bacterial or fungal nature;
• syphilitic, tuberculous lesions of the brain and spinal cord;
• subarachnoid bleeding;
• abscess of the central nervous system;
• ischemic, hemorrhagic stroke;
• traumatic brain injury;
• demyelinating lesions of the nervous system, such as multiple sclerosis;
• benign and malignant tumors of the brain and spinal cord, their membranes;
• Guienne-Barré syndrome;
• other neurological diseases.

Cerebrospinal fluid examination makes it possible to quickly diagnose serious illnesses brain and spinal cord

Contraindications

It is prohibited to take a lumbar puncture for space-occupying formations of the posterior cranial fossa or temporal lobe brain. In such situations, taking even a small amount of cerebrospinal fluid can cause dislocation brain structures and cause entrapment of the brain stem in the foramen magnum, which entails immediate death.

It is also prohibited to perform a lumbar puncture if the patient has purulent-inflammatory lesions of the skin, soft tissues, or spine at the puncture site.

Relative contraindications are severe spinal deformities (scoliosis, kyphoscoliosis, etc.), since this increases the risk of complications.

With caution, puncture is prescribed to patients with bleeding disorders, those who take drugs that affect blood rheology (anticoagulants, antiplatelet agents, non-steroidal anti-inflammatory drugs).

In case of brain tumors, lumbar puncture can be performed only for health reasons, since there is a high risk of developing dislocation of brain structures

Preparation stage

The lumbar puncture procedure requires preliminary preparation. First of all, the patient is prescribed general clinical and biochemical blood and urine tests, and the state of the blood coagulation system is necessarily determined. The lumbar spine is examined and palpated. To identify possible deformations that may interfere with the puncture.

You need to tell your doctor about all the medications you are currently taking or have recently taken. Special attention should be given to drugs that affect blood clotting (aspirin, warfarin, clopidogrel, heparin and other antiplatelet agents and anticoagulants, non-steroidal anti-inflammatory drugs).

You should also tell your doctor about possible allergies to medications, including anesthetics and contrast agents, or any recent acute diseases, about the presence of chronic ailments, since some of them may be a contraindication to the study. All women of childbearing age should tell their doctor if they may be pregnant.

Before performing a spinal cord puncture, the patient must consult a doctor.

It is forbidden to eat for 12 hours before the procedure and drink for 4 hours before the puncture.

Puncture technique

The procedure is performed with the patient lying on his side. In this case, you need to bend your legs as much as possible at the knee and hip joints, bringing them to the stomach. The head should be bent forward as much as possible and close to the chest. It is in this position that the intervertebral spaces widen well and it will be easier for the specialist to get the needle into the right place. In some cases, the puncture is performed with the patient sitting with the back as rounded as possible.

The specialist selects the puncture site by palpating the spine so as not to damage the nerve tissue. The spinal cord in an adult ends at the level of the 2nd lumbar vertebra, but in short people, as well as in children (including newborns), it is slightly longer. Therefore, the needle is inserted into the intervertebral space between the 3rd and 4th lumbar vertebrae or between the 4th and 5th. This reduces the risk of complications after puncture.

After skin treatment antiseptic solutions local infiltration anesthesia of soft tissues is performed with a solution of novocaine or lidocaine using a regular syringe with a needle. After this, a lumbar puncture is performed directly with a special large needle with a mandrel.

This is what a spinal puncture needle looks like

The puncture is made at the selected point, the doctor directs the needle sagittally and slightly upward. At approximately a depth of 5 cm, resistance is felt, after which a peculiar dip of the needle follows. This means that the end of the needle has entered the subarachnoid space and you can begin collecting cerebrospinal fluid. To do this, the doctor removes the mandrin from the needle ( inner part, which makes the instrument airtight) and liquor begins to drip from it. If this does not happen, you need to make sure that the puncture is performed correctly and that the needle enters the subarachnoid space.

After collecting the cerebrospinal fluid into a sterile tube, the needle is carefully removed and the puncture site is sealed with a sterile bandage. For 3-4 hours after the puncture, the patient should lie on his back or side.

The puncture is performed between the 3rd and 4th or 4th and 5th lumbar vertebrae

Cerebrospinal fluid examination

The first step in cerebrospinal fluid analysis is to assess its pressure. Normal values ​​in a sitting position are 300 mm. water Art., in a lying position – mm. water Art. As a rule, pressure is assessed indirectly - by the number of drops per minute. 60 drops per minute corresponds to the normal value of cerebrospinal fluid pressure in the spinal canal. Pressure increases during inflammatory processes of the central nervous system, with tumor formations, with venous stagnation, hydrocephalus and other diseases.

Next, the cerebrospinal fluid is collected into two 5 ml tubes. They are then used to carry out the necessary list of studies - physicochemical, bacterioscopic, bacteriological, immunological, PCR diagnostics, etc.

Depending on the results of the cerebrospinal fluid study, the doctor can recognize the disease and prescribe appropriate treatment

Consequences and possible complications

In the vast majority of cases, the procedure takes place without any consequences. Naturally, the puncture itself is painful, but pain is present only at the stage of inserting the needle.

Some patients may develop the following complications.

Post-puncture headache

It is generally accepted that after a puncture a certain amount of cerebrospinal fluid flows out of the hole, as a result of which intracranial pressure decreases and a headache occurs. This pain resembles a tension headache, has a constant aching or squeezing character, and decreases after rest and sleep. It can be observed for 1 week after the puncture; if cephalgia persists after 7 days, this is a reason to consult a doctor.

Traumatic complications

Sometimes traumatic complications of puncture can occur, when the needle can damage spinal nerve roots and intervertebral discs. This is manifested by back pain, which does not occur after a correctly performed puncture.

Hemorrhagic complications

If large blood vessels are damaged during the puncture, bleeding and hematoma formation may occur. This is a dangerous complication that requires active medical intervention.

Dislocation complications

Occurs when there is a sharp drop in cerebrospinal fluid pressure. This is possible in the presence of space-occupying formations in the posterior cranial fossa. To avoid such a risk, before taking a puncture, it is necessary to perform a study for signs of dislocation of the midline structures of the brain (EEG, REG).

Infectious complications

They may occur due to violation of the rules of asepsis and antisepsis during puncture. The patient may develop inflammation of the meninges and even form abscesses. Such consequences of puncture are life-threatening and require the prescription of powerful antibacterial therapy.

Thus, spinal cord puncture is a very informative technique for diagnosing a large number of diseases of the brain and spinal cord. Naturally, complications during and after the manipulation are possible, but they are very rare, and the benefit of the puncture far outweighs the risk of developing negative consequences.

Comments

Do not let doctors take this liquid.

Good afternoon, tell me the reason why you can’t give it. I have three children, they were admitted to the hospital and three of them are suspected of meningitis, one child was confirmed, what to do, tell me.

You can do it! Don't listen to anyone, this is a completely safe diagnostic method. The main thing is an experienced doctor. And your positive attitude. I did it twice with a break of 3 years. After the procedure, it was, of course, a little difficult, but you need to drink a lot of water (I drank 5 liters a day), bed rest, and after 5-7 days you will completely return to normal! But most of the people who were in the room with me had it very well, although they complained of headaches, but this was because they didn’t drink water and were on their feet all day! And during the analysis, the main thing is to relax and follow all the doctor’s instructions. Don’t worry and feel free to do everything you’ve been assigned to do. And be healthy!

How can one not allow such an analysis to be carried out if we are talking about establishing such serious illness The child has meningitis! There is no longer a choice, especially given the current outbreak of this disease. In most children admitted to the hospital with meningeal syndrome, it is confirmed after a puncture. I myself am now in an infectious diseases hospital with my youngest daughter, it was confirmed and it’s scary to imagine what would have happened if we had not been hospitalized on time. Here the entire hospital is jam-packed, including the corridors, with children with the same diagnosis. The doctors themselves are shocked by this situation. And today the body of a one-year-old girl was brought to the hospital; yesterday the parents refused hospitalization, but today they simply didn’t have time to bring it. Of course, a puncture is a procedure that God forbid anyone experiences, but if it concerns life and health, there should be no doubt.

Good afternoon Vera, what city are you in, and where is the outbreak? My child and I are also in the hospital now with meningitis, we are already recovering! The puncture has already been taken 3 times. There are no other options anyway! And this is a very revealing analysis! They will take it again before discharge! The main thing is that everything turns out to be normal!

Hello! Tell me, we are going to have this test and if meningitis is confirmed, can this disease be treated?

How often can this procedure be performed?

How would you feel about the fact that this procedure will be performed by a trainee and after a while you will begin to have back problems?

Not a single doctor admits to his mistake, if anything, moreover, with every intervention on the part of the clinic, we are required to sign consent for this, thereby relieving the clinic of all responsibility if something goes wrong, and prove that you are not a camel, that’s our free Soviet medicine.

They said, if you have a choice between putting a child in a coffin with meningitis or a puncture that is risky by your standards, what will you choose?

My son had a puncture on March 7, after the puncture he was sent to the ward, they didn’t tell him that he had to lie down, he was on his feet, sitting. After 2 days, they said that the diagnosis of meningitis was not confirmed and we removed him from the infection. In the evening at home, his head and back began to hurt while sitting and standing, but the pain went away when lying down. Today is March 12, but the pain has not gone away yet, what should I do?

Julia, it looks like post-puncture syndrome. Doctors say - bed rest, and drink a lot of fluid to produce cerebrospinal fluid, for an adult 4 liters, for a child - ask your doctor.

It is believed that it should pass within a day, i.e. the hole will close and the volume of cerebrospinal fluid will be replenished.

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What you need to know about spinal tap

Lumbar puncture of the spinal cord is performed on lumbar level spinal column. During the operation, a needle is inserted between several vertebrae in the lumbar spine to obtain a sample of cerebrospinal fluid. This is required for anesthesiological or therapeutic purposes, that is, when anesthetizing the area or carrying out any medical procedures is required.

Bone marrow puncture makes it possible to detect:

1. Meningitis.
2. Neurosyphilis.
3. Various CNS disorders.
4. Abscess.
5. Multiple demyelinating sclerosis.
6. All kinds of cancer of the spinal cord and brain.

In some cases, a bone marrow puncture is used to administer pain medications. This is mainly required when chemotherapy is being administered.

What is it for?

1. The need for spinal cord fluid for examination.
2. Determining the pressure indicator in the spinal cord fluid.
3. Cisternography and myelography.
4. Administration of chemotherapy medication and medicinal solution.

The patient is injected with pigment solutions or radioactive compounds to obtain a clear image of the fluid stream.

Thanks to the analysis results, it is possible to detect:

1. Dangerous microbes, fungal and viral infections, in particular syphilis, meningitis and encephalitis.
2. Hemorrhages into the subarachnoid medullary space (SAC).
3. Certain types of cancer that start in the spinal cord and brain.
4. Most of the inflammations of the central nervous system, for example, multiple sclerosis, acute polyradiculitis and various paralysis.

Consequences and risks

Bone marrow puncture is a rather dangerous event. Its correct removal is carried out only by a qualified doctor who has specialized tools and in-depth knowledge.

Negative consequences and complications include:

1. headaches;
2. discomfort;
3. bleeding;
4. increased intracranial pressure;
5. hernia formations;
6. development of cholesteoatoma.

Taking into account the current clinical picture, experts recommend maintaining a sedentary lifestyle and bed rest during the first few days after the puncture.

Regarding the appearance of persistent pain in the spine, this is a fairly common ailment experienced by patients. The pain is localized both at the puncture site and spreads down the back of the legs.

Contraindications

The procedure is not used in cases of suspected or detected brain dislocation, as well as in the presence of brainstem symptoms.

If the pictorial pressure in the spiral volume drops, then the puncture is not performed, since very dangerous consequences are possible. It triggers the mechanism of infringement of the brain column, due to which the operation can lead to the death of the patient.

Particular care must be taken if the procedure is performed if there is a bleeding disorder, a tendency to bleed, or if you are taking medications that thin the blood. These include:

1. clopidogrel;
2. warfarin;
3. some commercial analgesics, such as naproxen sodium or aspirin.

How is the procedure performed?

A spinal cord puncture is performed in a clinic or in a hospital setting. Before the procedure, the patient’s back is washed with antiseptic soap, disinfected with alcohol or iodine, and then covered with a sterile napkin. The place where the puncture will be made must be disinfected with an effective anesthetic.

This procedure is done between the 3rd and 4th or 4th and 5th vertebrae. The curve outlining the apex of the iliac vertebral bone serves as a guide for the interspinous space.

The patient is placed in a horizontal position on the right or left side. Thus, he should lie down in the fetal position. The skin in the area where the puncture will be made is treated with alcohol or iodine. In addition, the puncture site requires anesthesia by injecting a novocaine solution under the skin.

While anesthesia is in effect, a specialist punctures the intrathecal space using a medical needle with a mandrel, the length of which is about cm, and the thickness is 0.5-1 mm. The needle is inserted strictly in the sagittal plane and directed slightly upward, that is, in accordance with the imbricated location of the spinous formation.

As the needle approaches the intrathecal space, it will experience resistance from the fact that it comes into contact with the copper and yellow ligament; it easily overcomes the layer of fatty tissue and encounters resistance when it passes through the strong meninges.

When a puncture occurs, the doctor and patient feel as if the needle is falling through. This phenomenon is quite normal, do not be afraid. The needle moves along the course a few millimeters and the mandrel is removed from it. After this, cerebrospinal fluid should begin to flow out of the needle. In its normal state, the liquid is transparent and flows out in scanty drops. Modern manometers are used to measure the pressure in the cerebrospinal fluid.

It is impossible to draw out the cerebrospinal fluid with a syringe, as this leads to pinching of the brain stem and dislocation of the brain.

After the pressure has been determined and the cerebrospinal fluid has been taken, the needle is removed and the puncture area is sealed with a sterile pad. The cerebrospinal fluid is collected over a period of approximately 45 minutes. After the puncture, the patient must remain in bed for at least a day.

What happens after

Patients are prohibited from performing active or strenuous work on the day of the procedure. Return to normal life is possible only after the permission of the treating specialist.

After puncture, a large number of patients are recommended to take painkillers to help relieve headaches and pain syndrome at the puncture site.

The fluid sample that was removed by puncture is placed in a box and delivered to the laboratory for analysis. Thanks to research activities, the laboratory assistant finds out:

1. cerebrospinal fluid indicator;
2. protein concentration;
3. white blood cell concentration;
4. presence of microorganisms;
5. the presence of disfigured and cancerous cells in the sample.

What indicators should cerebrospinal fluid have in a normal state? A good result will be characterized by transparency and colorlessness of the liquid. If the sample is yellowish, dull or pinkish in color, this indicates the presence of infection.

If the protein exceeds the normal value, this may indicate poor health of the patient, as well as the fact that inflammation has begun to develop. If the protein content exceeds the level of 45 mg/dl, then the presence of infections and destructive processes is possible.

Equally important is the concentration of white blood cells. A sample in normal condition contains no more than 5 mononuclear leukocytes. If their number increases, this indicates the presence of infection.

Pay attention to glucose concentration. Thanks to low level sugar in the sample taken confirms the presence of infection and other pathological processes.

If germs, viruses, fungi and other microorganisms were found, this indicates the presence of infection.

If cancerous, malformed or immature blood cells are found, this may confirm the presence of some type of cancer.

Spinal puncture: when performed, procedure, interpretation, consequences

Spinal puncture is the most important diagnostic method for a number of neurological and infectious diseases, as well as one of the routes for administering drugs and anesthesia. Usage modern methods studies such as CT and MRI have reduced the number of punctures performed, but specialists cannot yet completely abandon it.

Patients sometimes mistakenly call the procedure for collecting cerebrospinal fluid a spinal cord puncture, although the nerve tissue should in no case be damaged or get into the puncture needle. If this happens, then we are talking about a violation of technique and a gross mistake by the surgeon. Therefore, it is more correct to call the procedure a puncture of the subarachnoid space of the spinal cord, or a spinal puncture.

CSF, or cerebrospinal fluid, circulates under the meninges and into ventricular system, providing trophism to nervous tissue, support and protection of the brain and spinal cord. With pathology, its quantity can increase, provoking an increase in pressure in the skull; infections are accompanied by changes in cellular composition; in case of hemorrhages, blood is found in it.

A puncture in the lumbar region can be either purely diagnostic in nature, when the doctor prescribes a puncture to confirm or make the correct diagnosis, or therapeutic, if medications are injected into the subarachnoid space. Increasingly, puncture is used to provide anesthesia for organ surgeries. abdominal cavity and small pelvis.

Like any invasive intervention, spinal puncture has a clear list of indications and contraindications, without which it is impossible to ensure the patient’s safety during and after the procedure. Such an intervention is not prescribed just like that, but there is also no need to panic prematurely if the doctor considers it necessary.

When is it possible and why not to do a spinal tap?

Indications for spinal puncture are:

• Possible infection of the brain and its membranes - syphilis, meningitis, encephalitis, tuberculosis, brucellosis, typhus, etc.;
• Diagnostics intracranial hemorrhages and neoplasms, when other methods (CT, MRI) do not provide the required amount of information;
• Determination of liquor pressure;
• Coma and other types of disorders of consciousness without signs of dislocation and herniation of stem structures;
• The need to administer cytostatics and antibacterial agents directly under the membranes of the brain or spinal cord;
• Administration of contrast during radiography;
• Removal of excess cerebrospinal fluid and reduction of intracranial pressure in hydrocephalus;
• Demyelinating, immunopathological processes in nervous tissue (multiple sclerosis, polyneuroradiculoneuritis), systemic lupus erythematosus;
• Unexplained fever, when pathology of other internal organs is excluded;
• Conducting spinal anesthesia.

In case of infectious damage to the brain tissue and its membranes, a spinal puncture has not only an important diagnostic value for determining the type of pathogen. It makes it possible to determine the nature of subsequent treatment, the sensitivity of microbes to specific antibiotics, which is important in the process of fighting infection.

When intracranial pressure increases, spinal cord puncture is considered perhaps the only way to remove excess fluid and relieve the patient from many unpleasant symptoms and complications.

The introduction of antitumor drugs directly under the membranes of the brain significantly increases their concentration in the focus of neoplastic growth, which makes it possible not only to have a more active effect on tumor cells, but also to use a higher dosage of drugs.

Thus, cerebrospinal fluid is taken to determine its cellular composition, the presence of pathogens, blood admixtures, identify tumor cells and measure the pressure of the cerebrospinal fluid in its circulation, and the puncture itself is carried out when drugs or anesthetics are administered.

In case of a certain pathology, a puncture can cause significant harm and even cause the death of the patient, therefore, before prescribing it, possible obstacles and risks must be eliminated.

Contraindications to spinal tap include:

1. Signs or suspicion of dislocation of brain structures due to swelling, neoplasm, hemorrhage - a decrease in the pressure of the cerebrospinal fluid will accelerate the herniation of the brainstem sections and can cause the death of the patient directly during the procedure;
2. Hydrocephalus caused by mechanical obstacles to the movement of cerebrospinal fluid (adhesions after infections, operations, congenital defects);
3. Bleeding disorders;
4. Purulent and inflammatory processes of the skin at the puncture site;
5. Pregnancy (relative contraindication);
6. Aneurysm rupture with ongoing bleeding.

Features of the conduct and indications for spinal puncture determine the nature preoperative preparation. As before any invasive procedure, the patient will have to undergo blood and urine tests, undergo a blood coagulation study, CT scan, and MRI.

It is extremely important to notify the doctor about all medications taken, allergic reactions in the past, and concomitant pathologies. All anticoagulants and angioplatelet agents are discontinued at least a week in advance due to the risk of bleeding, as well as anti-inflammatory drugs.

Women who are scheduled for cerebrospinal fluid puncture and, especially, during X-ray contrast studies, must be sure that they are not pregnant in order to exclude a negative effect on the fetus.

The patient either comes for the study himself, if the puncture is planned on an outpatient basis, or he is taken to treatment room from the department where he is being treated. In the first case, you should think in advance about how and with whom you will have to get home, since weakness and dizziness are possible after the manipulation. Before the puncture, experts recommend not eating or drinking for at least 12 hours.

In children, the reason for a spinal puncture can be the same diseases as in adults, but most often these are infections or a suspicion of a malignant tumor. A prerequisite for the operation is the presence of one of the parents, especially if the child is small, scared and confused. Mom or dad should try to calm the baby and tell him that the pain will be quite bearable, and the study is necessary for recovery.

Typically, a spinal puncture does not require general anesthesia; local anesthetics are sufficient to make the patient comfortable. In more rare cases (allergy to novocaine, for example), puncture without anesthesia is allowed, and the patient is warned about possible pain. If there is a risk of cerebral edema and dislocation during a spinal puncture, then it is advisable to administer furosemide half an hour before the procedure.

Spinal puncture technique

To perform a puncture of cerebrospinal fluid, the subject is placed on a hard table on the right side, the lower limbs are raised to the abdominal wall and clasped with the arms. It is possible to perform the puncture in a sitting position, but the back should also be bent as much as possible. In adults, punctures are allowed below the second lumbar vertebra, in children, due to the risk of damage to spinal tissue, no higher than the third.

The spinal tap technique does not present any difficulties for a trained and experienced specialist, and its careful adherence helps to avoid serious complications. Puncture of cerebrospinal fluid includes several successive stages:

• Preparatory - a sterile needle with a mandrel, containers for collecting cerebrospinal fluid, one of which is sterile with a stopper, are prepared by the nurse immediately before the procedure; the doctor uses sterile gloves, which are additionally wiped with alcohol;
• The patient lies on his right side, bends his knees, the assistant further bends the patient’s spine and fixes him in this position;
• The nurse assisting in the operation lubricates the needle insertion site in the lumbar region, starting from the puncture point and towards the periphery, twice with iodine, then three times with ethanol to remove iodine;
• The surgeon palpates the puncture site, determines the iliac crest, mentally draws a perpendicular line from it to the spine, which falls into the gap between the 3rd and 4th lumbar vertebrae; puncture can be done here or on the vertebra upward; these places are considered safe, since the substance of the spinal cord is on this level is missing;
• Local anesthesia is carried out using novocaine, lidocaine, procaine, which are injected into the skin until the soft tissues are completely anesthetized;
• A needle is inserted into the intended puncture site with a cut upward at a right angle to the surface of the skin, then carefully, slightly tilting it in the direction of the patient’s head, it is moved deeper, while the doctor will feel three dips of the needle - after puncture of the skin, intervertebral ligament and dura mater of the spinal cord;
• The third failure indicates that the needle has penetrated into the intrathecal space, after which the mandrel is removed. At this moment, cerebrospinal fluid may be released, and if it is not, then the needle is inserted deeper, but very carefully and slowly due to the proximity of the choroid plexus and the risk of bleeding;
• When the needle is in the spinal cord canal, the cerebrospinal fluid pressure is measured - using a special pressure gauge or visually, based on the intensity of the cerebrospinal fluid flow (normally - up to 60 drops per minute);
• The actual collection of spinal puncture in 2 test tubes: 2 ml of liquid for bacteriological analysis is placed in the sterile one, cerebrospinal fluid is placed in the second one, sent for analysis of cellular composition, protein levels, sugar, etc.;
• When the cerebrospinal fluid is obtained, the needle is removed, the puncture site is covered with a sterile napkin and sealed with a band-aid.

The specified algorithm of actions is mandatory regardless of the indications and age of the patient. The risk depends on the accuracy of the doctor’s actions the most dangerous complications, and in the case of spinal anesthesia - the degree and duration of pain relief.

The volume of fluid obtained during puncture is up to 120 ml, but 2-3 ml is sufficient for diagnosis, used for further cytological and bacteriological analyses. During the puncture, pain at the puncture site is possible, so especially sensitive patients are advised to undergo pain relief and the administration of sedatives.

During the entire procedure, it is important to maintain maximum stillness, so adults are held in the desired position by a doctor’s assistant, and the child is held by one of the parents, who also helps the baby calm down. In children, anesthesia is mandatory and helps ensure peace of mind for the patient, and gives the doctor the opportunity to act carefully and slowly.

Many patients are afraid of puncture, because they are sure that it hurts. In reality, the puncture is quite tolerable, and pain is felt at the moment the needle penetrates the skin. As the soft tissues become “saturated” with the anesthetic, the pain goes away, a feeling of numbness or bloating appears, and then all negative sensations disappear altogether.

Postoperative period and possible complications

After taking the cerebrospinal fluid, the patient is not lifted, but is taken in a supine position to the ward, where he lies on his stomach for at least two hours without a pillow under his head. Babies up to one year old are placed on their backs with a pillow under their buttocks and legs. In some cases, the head end of the bed is lowered, which reduces the risk of dislocation of brain structures.

For the first few hours, the patient is under careful medical supervision; specialists monitor his condition every quarter of an hour, since the flow of cerebrospinal fluid from the puncture hole can continue for up to 6 hours. If signs of edema and dislocation of the brain regions appear, urgent measures are taken.

After a spinal tap, strict bed rest is required. If the cerebrospinal fluid levels are normal, then after 2-3 days you can get up. In case of abnormal changes in the punctate, the patient remains on bed rest for up to two weeks.

A decrease in fluid volume and a slight decrease in intracranial pressure after a spinal tap can trigger headache attacks that can last about a week. It can be relieved with analgesics, but in any case, if such a symptom occurs, you should talk to your doctor.

Collecting cerebrospinal fluid for research may be associated with certain risks, and if the puncture algorithm is violated, the indications and contraindications are not carefully assessed, or the patient’s general condition is severe, the likelihood of complications increases. The most likely, although rare, complications of a spinal puncture are:

1. Displacement of the brain due to the outflow of a large volume of cerebrospinal fluid with dislocation and wedging of the brainstem and cerebellum into the occipital foramen of the skull;
2. Pain in the lower back, legs, sensory disturbances due to spinal cord root injury;
3. Post-puncture cholesteatoma, when epithelial cells enter the spinal cord canal (using low-quality instruments, lack of a mandrel in the needles);
4. Hemorrhage due to injury to the venous plexus, including subarachnoid;
5. Infection followed by inflammation of the soft membranes of the spinal cord or brain;
6. If antibacterial drugs or radiopaque substances enter the intrathecal space, symptoms of meningism with severe headache, nausea, and vomiting occur.

Consequences after a properly performed spinal tap are rare. This procedure makes it possible to diagnose and effectively treat, and in case of hydrocephalus it is itself one of the stages in the fight against pathology. Danger during puncture may be associated with a puncture, which can lead to infection, damage to blood vessels and bleeding, as well as dysfunction of the brain or spinal cord. Thus, spinal puncture cannot be considered harmful or dangerous if the indications and risks are correctly assessed and the procedure algorithm is followed.

Evaluation of the result of spinal puncture

Result cytological analysis The cerebrospinal fluid is ready on the day of the study, and if bacteriological culture and assessment of the sensitivity of microbes to antibiotics is necessary, the wait for an answer can last up to a week. This time is necessary for microbial cells to begin to multiply in nutrient media and show their response to specific drugs.

Normal cerebrospinal fluid is colorless, transparent, and does not contain red blood cells. The permissible amount of protein in it is no more than 330 mg per liter, the sugar level is approximately half of that in the patient’s blood. It is possible to find leukocytes in the cerebrospinal fluid, but in adults the norm is considered to be up to 10 cells per µl, in children it is slightly higher depending on age. Density is 1.005-1.008, pH - 7.35-7.8.

An admixture of blood in the cerebrospinal fluid indicates hemorrhage under the membranes of the brain or injury to the vessel during the procedure. To distinguish between these two reasons, the liquid is taken into three containers: in case of hemorrhage, it is colored homogeneously red in all three samples, and in case of damage to the vessel, it becomes lighter from the 1st to the 3rd tube.

The density of cerebrospinal fluid also changes with pathology. So, in case inflammatory reaction it increases due to cellularity and the protein component, and with excess fluid (hydrocephalus) it decreases. Paralysis, brain damage from syphilis, and epilepsy are accompanied by an increase in pH, and with meningitis and encephalitis it falls.

The cerebrospinal fluid may darken with jaundice or metastases of melanoma, it turns yellow with an increase in the content of protein and bilirubin, after a previous hemorrhage under the membranes of the brain.

The biochemical composition of the cerebrospinal fluid also indicates pathology. Sugar levels decrease with meningitis and increase with strokes, lactic acid and its derivatives increase in the case of meningococcal lesions, abscesses of brain tissue, ischemic changes, and viral inflammation, on the contrary, leads to a decrease in lactate. Chlorides increase with neoplasms and abscess formation, and decrease with meningitis and syphilis.

According to reviews from patients who have undergone a spinal puncture, the procedure does not cause significant discomfort, especially if it is performed by a highly qualified specialist. Negative consequences are extremely rare, and patients experience the main concern at the stage of preparation for the procedure, while the puncture itself, performed under local anesthesia, is painless. After a month after the diagnostic puncture, the patient can return to his usual lifestyle, unless the result of the study requires otherwise.

What is a spinal puncture, does it hurt, possible complications

If we consider everything existing species diagnostic studies, then spinal cord puncture is rightfully considered one of the most complex research methods. Fluid collection should be performed by a qualified surgeon, exclusively in a hospital setting.

What is a spinal tap

A spinal or lumbar puncture is the collection of cerebrospinal fluid. During the procedure, despite the name, the spinal cord is not affected. For diagnostic studies, it is the cerebrospinal fluid, the fluid surrounding the spinal canal, that is used.

Why is a spinal puncture done?

A spinal puncture is performed if the development of infectious diseases or cancer is suspected. A diagnostic test is performed to confirm or clarify the diagnosis.

A spinal tap is taken to measure the pressure in the spinal canal. The procedure may also introduce a marker (in an MRI or CT scan using contrast) or a drug.

Preparing for a spinal tap

No special preparation of the patient is required for cerebrospinal fluid puncture. It is enough to find out about the presence of allergic reactions to painkillers. During the procedure, local anesthesia is used. The patient is first given an allergy test and only after that proceeds to the procedure itself.

Is it painful to have a spinal tap?

The procedure for collecting cerebrospinal fluid has been used for about 100 years. Initially, the puncture was done “live”, without the use of anesthetics and therefore was painful. Modern technology for the collection procedure involves the use of local anesthesia.

How to take a puncture

The patient is placed on the couch. The puncture site is injected with anesthetics. After the anesthesia has taken effect, proceed directly to the procedure itself:

• The patient is placed on the couch. The patient's position during spinal puncture is as follows: knees pressed to the stomach, chin to the chest. Anatomically, this position of the body leads to the expansion of the processes of the spine and unhindered insertion of the needle.

After the procedure

Collecting fluid for research takes only a few minutes. After a spinal puncture, the patient must be placed on a flat, hard surface. The patient is advised to remain still for the first two hours.

• Headaches after a puncture are reminiscent of the sensations that a person experiences during a migraine. Usually accompanied by nausea, sometimes vomiting. Painful sensations relieved with drugs from the NSAID group.

Recovery after puncture takes 2 days. Further hospitalization is prescribed according to indications, taking into account the patient’s well-being.

Why is a spinal tap dangerous?

The danger of collecting a puncture still exists. The patient and the doctor need to soberly assess the situation and possible negative effects due to the procedure.

• Contact of the anesthetic on the membrane of the spinal cord. Paralysis of the lower extremities develops, and convulsions are observed.

Is it possible to replace a spinal tap with something?

A complex algorithm for performing a spinal puncture and possible complications after the procedure have led to the fact that European clinics rarely resort to this type of research. But to clarify the diagnosis, a clinical study of the cerebrospinal fluid may be required, so this can be completely avoided. diagnostic procedure unreal.

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Spinal cord puncture (lumbar puncture) is a type of diagnosis that is quite complex. The procedure removes a small amount of cerebrospinal fluid or injects drugs and other substances into the lumbar spinal canal. In this process, the spinal cord is not directly affected. The risk that arises during puncture contributes to the rare use of the method exclusively in a hospital setting.

Purpose of a spinal tap

Spinal cord puncture is performed for:

Performing a spinal tap

collecting a small amount of cerebrospinal fluid (CSF). Subsequently, their histology is carried out; measuring the pressure of cerebrospinal fluid in the spinal canal; removing excess cerebrospinal fluid; introducing drugs into the spinal canal; facilitating difficult labor in order to prevent painful shock, as well as as anesthesia before surgery; determining the nature of the stroke; discharge tumor markers; cisternography and myelography.

Using a spinal tap, the following diseases are diagnosed:

bacterial, fungal and viral infections (meningitis, encephalitis, syphilis, arachnoiditis); subarachnoid bleeding (hemorrhages in the brain); malignant tumors of the brain and spinal cord; inflammatory conditions of the nervous system (Guillain-Barre syndrome, multiple sclerosis); autoimmune and dystrophic processes.

Often a spinal tap is equated with a bone marrow biopsy, but this statement is not entirely correct. During a biopsy, a tissue sample is taken for further research. Access to the bone marrow is achieved through a puncture of the sternum. This method allows you to identify bone marrow pathologies, some blood diseases (anemia, leukocytosis and others), as well as metastases in the bone marrow. In some cases, a biopsy can be performed during the puncture process.

To prevent and treat JOINT DISEASES, our regular reader uses the increasingly popular NON-SURGERY treatment method recommended by leading German and Israeli orthopedists. After carefully reviewing it, we decided to offer it to your attention.

Indications for spinal cord puncture

Spinal cord puncture is mandatory for infectious diseases, hemorrhages, and malignant neoplasms.

A puncture is taken in some cases for relative indications:

inflammatory polyneuropathy; fever of unknown pathogenesis; demyelinating diseases (multiple sclerosis); systemic connective tissue diseases.

Preparatory stage

Before the procedure, medical workers explain to the patient why the puncture is being performed, how to behave during the procedure, how to prepare for it, as well as possible risks and complications.

Spinal cord puncture requires the following preparation:

Registration of written consent for the manipulation. Submission of blood tests, which evaluate its coagulability, as well as the functioning of the kidneys and liver. Hydrocephalus and some other diseases require computed tomography and MRI of the brain. Collection of information on the history of the disease, recent and chronic pathological processes.

The specialist must be informed about the medications taken by the patient. medicines, especially those that thin the blood (Warfarin, Heparin), relieve pain, or have an anti-inflammatory effect (Aspirin, Ibuprofen). The doctor should be aware of existing allergic reactions caused by local anesthetics, anesthesia drugs, iodine-containing agents (Novocaine, Lidocaine, iodine, alcohol), as well as contrast agents.

It is necessary to stop taking blood thinning drugs, as well as analgesics and non-steroidal anti-inflammatory drugs in advance.

Before the procedure, water and food are not consumed for 12 hours.

Women must provide information about their suspected pregnancy. This information is required due to the intended X-ray examination during the procedure and the use of anesthetics, which may have an undesirable effect on the unborn child.

Your doctor may prescribe a medication to take before the procedure.

The presence of a person who will be next to the patient is mandatory. A child is allowed to undergo a spinal puncture in the presence of his mother or father.

Technique of the procedure

A spinal cord puncture is performed in a hospital ward or treatment room. Before the procedure, the patient empties his bladder and changes into hospital clothes.

Spinal cord puncture

The patient lies on his side, bends his legs and presses them to his stomach. The neck should also be in a bent position, with the chin pressed to the chest. In some cases, spinal puncture is performed with the patient sitting. The back should be as motionless as possible.

The skin in the puncture area is cleaned of hair, disinfected and covered with a sterile napkin.

The specialist may use general anesthesia or use a local anesthetic. In some cases, a drug with a sedative effect may be used. Also during the procedure, heartbeat, pulse and blood pressure are monitored.

The histological structure of the spinal cord provides for the safest needle insertion between the 3rd and 4th or 4th and 5th lumbar vertebrae. Fluoroscopy allows you to display a video image on a monitor and monitor the manipulation process.

Next, the specialist takes cerebrospinal fluid for further research, removes excess cerebrospinal fluid or injects necessary drug. The liquid is released without outside help and fills the test tube drop by drop. Next, the needle is removed and the skin is covered with a bandage.

CSF samples are sent for laboratory testing, where histology occurs directly.

Spinal cord cerebrospinal fluid

The doctor begins to draw conclusions based on the nature of the fluid coming out and its appearance. In its normal state, the cerebrospinal fluid is transparent and flows out one drop per second.

At the end of the procedure you must:

compliance with bed rest for 3 to 5 days as recommended by a doctor; keeping the body in a horizontal position for at least three hours; avoiding physical activity.

When the puncture site is very painful, you can resort to painkillers.

Adverse consequences after spinal cord puncture occur in 1–5 cases out of 1000. There is a risk of:

axial herniation; meningism (symptoms of meningitis occur in the absence of an inflammatory process); infectious diseases of the central nervous system; severe headache, nausea, vomiting, dizziness. The head may hurt for several days; damage to the roots of the spinal cord; bleeding; intervertebral hernia; epidermoid cyst; meningeal reaction.

If the consequences of the puncture are expressed in chills, numbness, fever, a feeling of tightness in the neck, or discharge at the puncture site, you should immediately consult a doctor.

There is an opinion that during a spinal tap the spinal cord can be damaged. It is erroneous, since the spinal cord is located higher than the lumbar spine, where the puncture is directly made.

Contraindications to spinal cord puncture

Spinal cord puncture, like many research methods, has contraindications. Puncture is prohibited in case of sharply increased intracranial pressure, dropsy or cerebral edema, or the presence of various formations in the brain.

It is not recommended to take a puncture if there are pustular rashes in the lumbar region, pregnancy, impaired blood clotting, taking blood thinning drugs, or ruptured aneurysms of the brain or spinal cord.

In each individual case, the doctor must analyze in detail the risk of the manipulation and its consequences for the life and health of the patient.

It is advisable to contact an experienced doctor who will not only explain in detail why it is necessary to perform a spinal cord puncture, but will also carry out the procedure with minimal risk for the patient's health.

Do you often face the problem of back or joint pain?

Do you have a sedentary lifestyle? You cannot boast of a royal posture and try to hide your stoop under clothes? It seems to you that this will soon go away on its own, but the pain is only getting worse... Many methods have been tried, but nothing helps... And now you are ready to take advantage any opportunity that will give you the long-awaited well-being!

Spinal tap (lumbar puncture)- one of the most complex and responsible diagnostic methods. Despite the name, the spinal cord is not directly affected, but cerebrospinal fluid (CSF) is collected. The procedure is associated with a certain risk, therefore it is carried out only in case urgent need, in the hospital and by a specialist.

Why is a spinal cord puncture performed?

Spinal cord puncture is most often used to identify infections (meningitis), clarify the nature of a stroke, diagnose subarachnoid hemorrhage, multiple sclerosis, identify inflammation of the brain and spinal cord, and measure cerebrospinal fluid pressure. Also, a puncture can be performed to administer medications or a contrast agent during an X-ray examination to determine herniated intervertebral discs.

How is a spinal cord puncture taken?

During the procedure, the patient takes a position lying on his side, pressing his knees to his stomach and his chin to his chest. This position allows you to slightly move apart the processes of the vertebrae and facilitate the penetration of the needle. The area around the puncture is disinfected first with iodine and then with alcohol. Then local anesthesia is performed with an anesthetic (most often novocaine). The anesthetic does not provide complete pain relief, so the patient must prepare for some unpleasant sensations in advance in order to remain completely still.

The puncture is carried out with a special sterile needle up to 6 centimeters long. A puncture is made in the lumbar region, usually between the third and fourth vertebrae, but always below the spinal cord.

After inserting a needle into the spinal canal, cerebrospinal fluid begins to flow out of it. Typically, about 10 ml of cerebrospinal fluid is required for the study. Also, when taking a spinal cord puncture, the rate of its flow is assessed. In a healthy person, cerebrospinal fluid is clear and colorless and flows out at a rate of approximately 1 drop per second. In the case of increased pressure, the flow rate of the liquid increases, and it can even flow out in a trickle.

After receiving the required volume of liquid for research, the needle is removed and the puncture site is sealed with a sterile napkin.

Consequences of spinal cord puncture

After the procedure, for the first 2 hours the patient should lie on his back, on a flat surface (without a pillow). In the next 24 hours, it is not recommended to take a sitting or standing position.

Some patients may experience nausea, migraine-like pain, pain in the spine, and lethargy after a spinal tap is performed. For such patients, the attending physician prescribes painkillers and anti-inflammatory drugs.

If the puncture was performed correctly, then it does not have any negative consequences, and the unpleasant symptoms disappear quite quickly.

Why is spinal puncture dangerous?

The spinal cord puncture procedure has been performed for more than 100 years, and patients often have a prejudice against its use. Let us consider in detail whether spinal puncture is dangerous and what complications it can cause.

One of the most common myths is that during a puncture the spinal cord can be damaged and paralysis can occur. But, as mentioned above, a lumbar puncture is performed in the lumbar region, below the spinal cord, and thus cannot touch it.

There is also a concern about the risk of infection, but usually the puncture is carried out under the most sterile conditions. The risk of infection in this case is approximately 1:1000.

Possible complications after a spinal tap include the risk of bleeding (epidural hematoma), the risk of increased intracranial pressure in patients with tumors or other brain pathologies, and the risk of spinal nerve injury.

Thus, if a spinal cord puncture is performed by a qualified doctor, the risk is minimal and does not exceed the risk of performing a biopsy of any internal organ.

To date, many diagnostic methods have been invented that make it possible to make accurate diagnoses and exclude other pathological processes. To identify most pathologies, it is enough to do a tomography (computed tomography, magnetic resonance imaging) or x-ray, but there are diseases for which it is necessary to take cerebrospinal fluid for analysis. It represents cerebrospinal fluid and this type of examination is key in making many diagnoses. The main point in this procedure is the collection of material and for this a lumbar puncture (lumbar puncture) is performed. It is considered one of the most difficult and painful operations and is performed only by an experienced surgeon in a hospital setting.

Features of the procedure

The collection of cerebrospinal fluid has a certain technique, which must be strictly followed, because there is always a danger of touching the spinal cord. Sometimes a lumbar puncture is used to perform spinal anesthesia. This method of pain relief is used for many types of surgical intervention, for example, when removing a stone from the urinary tract or kidney.

Performing a lumbar puncture in children is carried out in a similar way, but in the case of children you will have to work hard to get the child to lie in one place and not move. Only an experienced doctor should undertake the procedure, because if the fence is done incorrectly, there will be consequences. If the procedure is successful, complications are usually minimal and resolve within 2-3 days.

Purpose of cerebrospinal fluid collection

The indications and contraindications for lumbar puncture are not particularly different from other procedures. By analyzing the cerebrospinal fluid, the presence of a malignant tumor, infection and other similar diseases can be excluded or confirmed. The list of reasons for spinal cord puncture includes the following pathological processes:

• Multiple sclerosis;
• Inflammation localized in the spinal cord and brain;
• Diseases caused by infections;
• Definitions of stroke type;
• Detection of internal bleeding;
• Checking tumor markers.

A spinal tap is taken in children and adults to accurately determine the pressure of the spinal canal. Sometimes the procedure is used to insert a special marker used in a contrast dye scan or to inject a medication.

Cerebrospinal fluid puncture is performed when various forms meningitis and other diseases caused by infections. It is also performed to determine the presence of cancer, as well as hematomas and rupture of an aneurysm (protrusion of the vessel wall).

Contraindications

Sometimes it is prohibited to take cerebrospinal fluid for analysis, as there is a possibility of harming the patient. Basically, contraindications to lumbar puncture are as follows:

• Severe cerebral swelling;
• Closed dropsy of the brain;
• Pressure surges inside the skull;
• Large tumor in the brain.

If there is 1 of these reasons, then a spinal tap is not performed, as it can cause another complication. During the puncture, some brain tissue may descend into the foramen magnum and become pinched there. This phenomenon is quite dangerous, because areas responsible for important systems of the body can be affected and a person will die as a result of their violations. Usually, the chances of such a consequence increasing if a thick needle was chosen for a spinal puncture or if significantly more cerebrospinal fluid was withdrawn than necessary.

However, sometimes such an analysis is vital and in such a situation a minimal amount of material is taken. If the slightest signs of prolapse of brain tissue occur, you should urgently compensate for the cerebrospinal fluid by injecting fluid through a puncture needle.

There are other contraindications for lumbar puncture, namely:

• Pregnancy;
• Pathologies that impair blood clotting;
• Skin diseases in the area of ​​cerebrospinal fluid puncture;
• Use of medications to thin the blood;
• ruptured aneurysms in the spinal cord or brain;
• Blockade of the subarachnoid space in the spinal cord.

If a person has one of the above reasons, then taking a spinal tap is not recommended. It is performed only in vital cases, but all possible complications are taken into account.

Preparation for the procedure

There are no special preparations before a lumbar puncture. It will be enough for the patient to study information about possible allergic reactions to the administration of an anesthetic drug and do an allergy test immediately before the procedure. After these fairly simple steps, the doctor will begin the operation.

The only point that needs to be taken into account is the psychological barrier. Many people do not understand why they need to psych themselves up additionally, but directly during the procedure, some patients panic greatly. This is especially true for children with their fragile psyches. The specialist has to constantly wriggle out in order to create all the necessary conditions for the patient to relax.

Pain during the procedure

Lumbar puncture has been performed for over a century and was originally performed without local anesthesia. This is why there are so many bad rumors about the procedure, because previously patients suffered greatly during the collection of cerebrospinal fluid and the spinal cord was often punctured due to the patient’s movements. Nowadays, the entire process takes place after the administration of painkillers.

The procedure itself is virtually painless, but during the puncture the patient feels discomfort. For this reason, the doctor must definitely warn the patient to be patient and not move until everything is over. Otherwise, the needle may jerk and touch other tissues.

Technique

For lumbar puncture, the technique is as follows:

• The patient lies down on the couch, and the doctor injects him with an anesthetic drug into the place where the puncture will be performed;
• Next, the doctor helps the patient take the desired position. The legs should be bent at the knees, which are pressed tightly to the stomach, and the chin should touch the chest and fix it in this position;
• After taking the desired position, the area where the spinal puncture will be performed is treated with antiseptics;
• A 6 cm long needle is inserted into the treated area. CSF is usually taken in the place between the 3rd and 4th vertebrae, and in infants above the tibia;
• At the end of the procedure, the needle is carefully pulled out and the wound is covered with a plaster.

Side effects after the procedure

The procedure usually lasts 3-5 minutes, but after the lumbar puncture the patient is transferred to a flat surface so that he lies motionless on it for at least 2 hours. Next, you need to maintain bed rest for 24 hours after performing a lumbar puncture.

Side effects after the procedure include the following:

• Headache. The pain in this case resembles a migraine and the patient often feels nauseous. In such a situation, anti-inflammatory and painkillers are used;
• General weakness. The patient feels fatigue and loss of strength after the puncture, and sometimes there is a paroxysmal pain at the site of the puncture. This side effect occurs due to a lack of cerebrospinal fluid, which will be restored over time.

In most cases, the patient feels better 1-2 days after the lumbar puncture was performed.

Complications after a puncture

You can understand why spinal puncture is dangerous by looking at this list:

• Injection of anesthetic directly into the spinal cord. In such a situation, the patient experiences paralysis of the lower limbs with convulsive seizures;
• Brain overload. Occurs mainly in cases of hemorrhage. Because of it, the cerebrospinal fluid comes out under strong pressure and the brain tissue is displaced. Against this background, pinching of the respiratory nerve often occurs;
• Complication due to non-compliance with established rules during the recovery period. The patient must strictly follow all the doctor’s instructions so as not to get an infection inside or get inflammation at the puncture site.

Lumbar puncture is a rather dangerous examination method and should be performed by an experienced doctor. It is advisable to do a puncture no more than once every six months and after the procedure you need to remain in bed.

Today there are many techniques that can be used to diagnose various diseases. One of them is spinal cord puncture. Thanks to this procedure, it is possible to identify such dangerous diseases as meningitis, neurosyphilis, and cancer.

Lumbar puncture is performed in the lumbar region. To obtain a sample of cerebrospinal fluid, a special needle is inserted between two vertebrae. In addition to diagnostic purposes, puncture can be performed to administer medications and for pain relief. The procedure is not always safe. Therefore, you need to know all the contraindications and possible complications before carrying out the procedure.

Goals and indications for the study

CSF (cerebrospinal fluid) is taken from the subarachnoid space; the spinal cord remains untouched during the procedure. Studying the material makes it possible to obtain information about a particular disease and prescribe the correct treatment.

Purposes of lumbar puncture:

• laboratory examination of cerebrospinal fluid;
• reducing pressure in the brain and spinal cord by removing excess fluid;
• measurement of cerebrospinal fluid pressure;
• administration of medications (analgesics, chemotherapy drugs), contrast agents (for myelography, cisternography).

More often, the study is prescribed to those patients who presumably have the following pathologies:

• CNS infections (encephalitis, meningitis);
• abscess;
• inflammation in the spinal cord and brain;
• ischemic stroke;
• skull injuries;
• tumor formations;
• bleeding in the subarachnoid space;
• multiple sclerosis.

IN therapeutic purposes Lumbar puncture is often used for herniated discs to administer medications. Given the certain danger of the procedure for the patient, it is recommended to perform it only in cases where it is absolutely necessary.

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Contraindications

Cerebrospinal fluid sampling is not performed for large formations in the posterior fossa of the skull or the temporal region of the brain. Such a procedure for these pathologies can cause pinching of the brain stem in the foramen of the head and lead to death.

You can’t do a puncture if a person has purulent inflammations skin, spinal column at the site of the proposed puncture. There is a high risk of complications after the procedure with obvious spinal deformities (kyphosis, scoliosis). The puncture should be performed very carefully in case of problems with blood clotting, as well as in people taking certain medications (Aspirin, Naproxen), anticoagulants (Warfarin, Clopidogrel).

There are no special preparatory measures before lumbar puncture. Before the procedure, patients undergo allergy tests to determine their tolerance to the injected painkillers. Before collecting cerebrospinal fluid, local anesthesia is required.

Process

The patient is placed on the couch on his side. Your knees should be pressed towards your stomach. Press your chin as close to your chest as possible. Thanks to this position, the processes of the spinal column move apart, the needle can be inserted without hindrance.

The area where the needle is inserted should be well disinfected with alcohol and iodine. Then an anesthetic (usually Novocaine) is injected. While the puncture is being performed, the patient should lie still. For the procedure, a disposable sterile 6-centimeter needle is taken, which is inserted at a slight angle. The puncture is made between the 3rd and 4th vertebrae below the level of the end of the spinal cord. In newborns, cerebrospinal fluid is taken from the upper part of the tibia.

If cerebrospinal fluid is taken for diagnostic purposes, only 10 ml is sufficient. A monometer is attached to the needle, which measures the intracerebral pressure of the cerebrospinal fluid. In a healthy person, the liquid is transparent and flows out in 1 second in a volume of 1 ml. With increased pressure this speed increases.

The pick-up lasts up to half an hour. The specialist monitors the progress of the procedure using fluoroscopy. After the required amount of liquid has been taken, the needle is carefully removed and a patch is applied to the puncture site.

After the procedure

After the manipulation, the person must lie down on a flat, hard surface and lie motionless for 2 hours. You cannot get up or sit during the day. Then for 2 days you need to stay in bed and drink as much fluid as possible.

Immediately after collecting the material, the patient may feel headaches resembling a migraine. They may be accompanied by nausea or vomiting. As the body recovers from the lack of cerebrospinal fluid, attacks of lethargy and weakness occur. There may be pain in the puncture area.

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CSF examination

When analyzing a liquid, its pressure is first assessed. The norm in a sitting position is 300 mm. water Art., in a lying position – 100-200 mm. water Art. pressure is assessed based on the number of drops per minute. If the pressure is elevated, this may indicate inflammatory processes in the central nervous system, the presence of tumors, and hydrocephalus.

The liquid is divided in two (5 ml in a test tube) and the cerebrospinal fluid is sent for further research:

• immunological;
• bacteriological;
• physico-chemical.

A healthy person has clear, colorless liquor. When a pink, yellow tint or dullness appears, we can talk about the presence of an infectious process.

Studying the concentration of proteins makes it possible to identify inflammatory process in organism. A protein reading of more than 45 mg/dL is a deviation from the norm, indicating the presence of infection. Infection is also indicated by an increase in the concentration of mononuclear leukocytes (the norm is up to 5). The liquor is also examined for glucose concentration, detection of viruses, bacteria, fungi, and detection of atypical cells.

Complications and possible consequences

Spinal cord puncture is a procedure that may involve dangerous consequences. Therefore, it should only be carried out by a qualified specialist with extensive experience and in-depth knowledge.

Possible complications:

• leakage of fluid into nearby tissues, which can cause severe headaches;
• paralysis of the lower extremities, convulsions if the anesthetic gets on the spinal membrane;
• massive hemorrhage due to increased load on the brain;
• needle damage to the spinal nerves can cause back pain;
• if the rules of antiseptics are violated, infection may occur, an inflammatory process or abscess of the meninges may develop;
• infringement of the nerve center, and as a result - impairment of respiratory function.

If you do not follow the rehabilitation rules after a lumbar puncture, this can also lead to serious complications.

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