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Lumbar puncture of the spinal cord (lumbar puncture, spinal, lumbar or spinal puncture) is performed in the lower back, in the region of the lumbar level of the spine. During surgery, a medical needle is inserted between the two lumbar bones of the spine (vertebrae) to either obtain a sample of cerebrospinal fluid, to numb the area for therapeutic or anesthetic purposes, or to administer treatment.

The procedure allows specialists to detect dangerous pathologies:

• meningitis;
• neurosyphilis;
• abscess;
• various disorders of the central nervous system;
• multiple demyelinating sclerosis;
• all kinds of brain and spinal cord cancer.

Sometimes doctors use a lumbar puncture to inject pain relievers during chemotherapy.

What is a puncture for?

• selection of cerebrospinal fluid for research;
• finding out the magnitude of the pressure in the cerebrospinal fluid;
• spinal anesthesia;
• the introduction of chemotherapy drugs and medicinal solutions;
• performing myelography and cisternography.

When puncture of the spinal cord for the listed procedures, the patient is injected with a pigment solution or a radioactive composition to obtain a clear display of the fluid stream.

The information collected during this procedure allows you to discover:

• dangerous microbial, viral and fungal infections, including encephalitis, syphilis and meningitis;
• hemorrhage in the subarachnoid space of the brain (SAH);
• some cancers that occur in the brain and spinal cord;
• most of the inflammatory conditions of the central nervous system, for example, multiple sclerosis, acute polyradiculitis, various paralysis.

Risks and consequences of a lumbar puncture

Lumbar puncture of the spine is a dangerous procedure. Only a qualified doctor with a special tool and deep knowledge can take a puncture correctly.

Manipulation of the spine can have negative consequences. They can lead to:

Where is the CSF needle going?

• headache;
• discomfort;
• bleeding;
• increased intracranial pressure;
• hernia formation;
• the development of cholesteatoma - a tumor-like formation containing dead epithelial cells and a mixture of other substances.

Quite often, patients experience severe headache after performing a lumbar puncture. The malaise occurs due to fluid leakage into closely spaced tissues.

Patients often notice headache while sitting and standing. It often goes away when the patient goes to bed. Taking into account the current picture, the attending physicians recommend that during the first 2-3 days after the operation, lead a sedentary lifestyle and observe bed rest.

Unrelenting spinal pain is a common discomfort experienced by patients undergoing a spinal cord puncture. The pain can be localized at the puncture site and spread down the back of the legs.

The main contraindications

Lumbar puncture of the spinal cord is categorically contraindicated in patients in whom dislocation of the brain is suspected or already identified, and the presence of stem symptoms is found.

A drop in cerebrospinal fluid pressure in the spinal volume (in the presence of an increased pressure focus) can have dangerous consequences. It can trigger the mechanisms of entrapment of the brain stem and thereby provoke the death of a patient in the operating room.

Special precautions should be taken when performing puncture in patients with bleeding disorders, people prone to bleeding, and those taking blood thinners (anticoagulants). These include:

• warfarin;
• clopidogrel;
• some commercial analgesics such as aspirin, ivalgin, or naproxen sodium.

How is the puncture performed?

Lumbar puncture can be performed in a polyclinic or in a hospital. Before the procedure, the patient's back is washed with an antiseptic soap, disinfected with alcohol or iodine and covered with a sterile napkin. The puncture site is disinfected with an effective anesthetic.

This puncture is done between the third and fourth or fourth and fifth spinous processes of the spine. The reference point for the interspinous gap is the curve that outlines the tops of the iliac bones of the spine.

Standard puncture site in the spine

The patient who will undergo the procedure is laid horizontally on a couch (on the left or right side). His bent legs are pressed to his stomach, and his head to his chest. The skin in the area of ​​the puncture is treated with iodine and alcohol. The puncture site is anesthetized by subcutaneous injection of a solution of novocaine.

During the period of anesthesia, the doctor punctures the intrathecal space with a medical needle with a mandrel 10-12 cm long and 0.5-1 mm thick. The doctor should insert the needle strictly in the sagittal plane and direct it somewhat upward (corresponding to the tiled location of the spinous formations).

The needle, as it approaches the intrathecal space, will experience resistance from the contact of the interspinous and yellow ligaments, it is easy to overcome the layers of epidural fatty tissue and meet resistance when passing through the strong meninges.

At the time of the puncture, the doctor and the patient may feel the needle falling through. This is quite normal and should not be feared. The needle should be advanced along the course by 1-2 mm and the mandrel should be removed from it. After removing the mandrel, CSF should flow out of the needle. Normally, the liquid should have a transparent color and flow out in scanty drops. To measure the pressure in the cerebrospinal fluid, modern manometers can be used.

Pulling the cerebrospinal fluid with a syringe is strictly prohibited, as this can lead to dislocation of the brain and pinching of the trunk.

After finding out the pressure and taking the cerebrospinal fluid, the syringe needle must be removed, the puncture area must be sealed with a sterile pad. The procedure takes approximately 45 minutes. A patient after a puncture must be in bed for at least 18 hours.

What happens after the procedure

Patients are prohibited from doing active and strenuous work on the day of the procedure. The patient can return to normal life only after the permission of the doctor.

A sample of fluid withdrawn by puncture is placed in a box and delivered to the laboratory for analysis. As a result of research activities, a laboratory assistant finds out:

• cerebrospinal fluid indicators;
• the concentration of protein in the sample;
• concentration of white blood cells;
• the presence of microorganisms;
• the existence of cancerous and disfigured cells in the sample.

What should be the indicators of cerebrospinal fluid? A good result is characterized by a clear, colorless liquid. If the specimen is dull, yellowish, or pinkish, this is evidence of infection.

The concentration of protein in the sample is studied (the presence of total protein and specific proteins). An increased protein content indicates poor health of the patient, the development of inflammatory processes. If the protein index is higher than 45 mg / dL, then infections and destructive processes may be present.

The concentration of white blood cells is important. The sample should normally contain up to 5 mononuclear leukocytes (white blood cells). An increase in the number of white blood cells indicates the presence of an infection.

Attention is drawn to the concentration of sugar (glucose). A low blood sugar level in the collected sample confirms the presence of infection or other pathological conditions.

Detection of microbes, viruses, fungi, or any microorganism indicates the development of an infection.

Finding cancerous, mutilated, or immature blood cells confirms the presence of some type of cancer.

Laboratory tests allow the doctor to establish an accurate diagnosis of the disease.

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Spinal cord puncture

A puncture of the spinal cord (lumbar puncture) is a type of diagnosis that is rather complicated. During the procedure, a small amount of cerebrospinal fluid is removed or drugs and other substances are injected into the lumbar spinal canal.

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

• taking a small amount of cerebrospinal fluid (cerebrospinal fluid). In the future, their histology is carried out;
• measuring the pressure of the cerebrospinal fluid in the spinal canal;
• removing excess cerebrospinal fluid;
• the introduction of drugs into the spinal canal;
• facilitating difficult labor in order to prevent pain shock, as well as anesthesia before surgery;
• determining the nature of the stroke;
• isolation of tumor markers;
• carrying out cisternography and myelography.

• bacterial, fungal and viral infections (meningitis, encephalitis, syphilis, arachnoiditis);
• subarachnoid bleeding (hemorrhage in the region of 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;
• demilienizing diseases (multiple sclerosis);
• systemic diseases of the connective tissues.

Preparatory stage

1. Writing a written consent to carry out the manipulation.
2. Delivery of blood tests, with the help of which its coagulability is assessed, as well as the work 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 history of the disease, on recent and chronic pathological processes.

Technique for performing the procedure

• adherence to bed rest for 3 to 5 days on the recommendation of a doctor;
• finding 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. The head may hurt for several days;
• damage to the roots of the spinal cord;
• bleeding;
• intervertebral hernia;
• epidermoid cyst;
• meningeal reaction.

• Are you sedentary?
• You can't boast of a royal posture and are trying to hide your stoop under your clothes?
• It seems to you that this will soon go away on its own, but the pains only intensify.
• 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 good health!

Lumbar puncture

Spinal cord puncture. Such a scary phrase can often be heard at a doctor's appointment, and it becomes even more scary when this procedure concerns you. Why do doctors puncture the spinal cord? Is this manipulation dangerous? What information can be obtained in the course of this study?

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

Why is a spinal cord puncture done? The purposes of such manipulation can be three - 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 the pathological processes occurring in the brain and spinal cord. But specialists can perform a puncture of the spinal cord for a therapeutic purpose, for example, for the introduction of drugs into the subarachnoid space, for a rapid decrease in spinal pressure. Also, do not forget about such a method of pain relief as spinal anesthesia, when anesthetics are injected into the spinal canal. This makes it possible to carry out a large number of surgical interventions without the use of general anesthesia.

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

Why take a puncture

A lumbar puncture is taken to examine the cerebrospinal fluid, which makes it possible to diagnose some diseases of the brain and spinal cord. Most often, such manipulation is prescribed if you suspect:

• 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.

Examination of cerebrospinal fluid makes it possible to quickly diagnose severe diseases of the brain and spinal cord

Contraindications

It is forbidden to take a lumbar puncture with space-occupying lesions of the posterior cranial fossa or temporal lobe of the brain. In such situations, the withdrawal of even a small amount of cerebrospinal fluid can cause dislocation of cerebral structures and cause infringement of the brain stem in the foramen magnum, which leads to immediate death.

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

Severe deformities of the spine (scoliosis, kyphoscoliosis, etc.) are relative contraindications, since this increases the risk of complications.

With caution, a puncture is prescribed for patients with bleeding disorders, those who take drugs that affect the rheology of the blood (anticoagulants, antiplatelet agents, nonsteroidal anti-inflammatory drugs).

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

Preparation phase

The lumbar puncture procedure requires preliminary preparation. First of all, the patient is assigned general clinical and biochemical blood and urine tests, the state of the blood coagulation system is necessarily determined. Examination and palpation of the lumbar spine are performed. To identify possible deformations that could interfere with the puncture.

You need to tell your doctor about all medications you are taking now or have recently used. Particular attention should be paid to drugs that affect blood clotting (aspirin, warfarin, clopidogrel, heparin and other antiplatelet and anticoagulants, nonsteroidal anti-inflammatory drugs).

You also need to inform the doctor about a possible allergy to medicines, including anesthetics and contrast agents, about recent acute illnesses, about the presence of chronic ailments, since some of them may be a contraindication to the study. All women of childbearing age should inform their doctor if they are pregnant.

Without fail, 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 carried out with the patient lying on his side. In this case, you need to bend the legs at the knee and hip joints as much as possible, bring them to the stomach. The head should be as bent forward as possible and close to the chest. It is in this position that the intervertebral spaces expand well and it will be easier for a specialist to get a needle in the right place. In some cases, the puncture is performed while the patient is sitting with the back as rounded as possible.

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

After treating the skin with antiseptic solutions, local infiltration anesthesia of soft tissues is performed with a solution of novocaine or lidocaine with an ordinary syringe with a needle. After that, the lumbar puncture is performed directly with a special large needle with a mandrel.

This is what a lumbar puncture needle looks like

The puncture is made at the selected point, the doctor directs the needle sagittally and slightly upward. Resistance is felt at a depth of about 5 cm, followed by a kind of needle failure. This means that the end of the needle has entered the subarachnoid space and you can start collecting cerebrospinal fluid. To do this, the doctor removes the mandrel from the needle (the inner part, which makes the instrument airtight) and cerebrospinal fluid 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 is in the subarachnoid space.

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

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

Cerebrospinal fluid examination

The first step in analyzing cerebrospinal fluid is to assess its pressure. Normal readings in a sitting position are 300 mm. water Art., in the supine position -mm. water Art. As a rule, the pressure is estimated indirectly - by the number of drops per minute. 60 drops per minute corresponds to the normal value of the pressure of the cerebrospinal fluid in the spinal canal. Pressure rises in inflammatory processes of the central nervous system, in tumor formations, in venous stasis, hydrocephalus, and other diseases.

Then the liquor is collected in two test tubes of 5 ml. 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 study of cerebrospinal fluid, 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 the pain is present only at the stage of needle insertion.

Some patients may develop the following complications.

Post dural puncture headache

It is generally accepted that a certain amount of cerebrospinal fluid flows out of the hole after the puncture, as a result of which intracranial pressure decreases and a headache occurs. Such 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 cephalalgia 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 the spinal nerve roots, intervertebral discs. This is manifested by back pain, which does not occur after a properly performed puncture.

Hemorrhagic complications

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

Dislocation complications

They arise with a sharp drop in cerebrospinal fluid pressure. This is possible in the presence of volumetric formations of 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 median structures of the brain (EEG, REG).

Infectious complications

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

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

Comments (1)

Do not let doctors take this liquid.

Good afternoon, tell me the reason why you can’t give. I have three children, were hospitalized and three have suspected meningitis, one child was confirmed what to do, tell me.

You can do it! Do not 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, hard, but you need to drink a lot of water (I drank 5 liters a day), bed rest, and after 5-7 days you are completely back to normal! But most of the people who were in the ward with me were very well tolerated, although they complained of headaches, but this is because they did not 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. Do not worry and feel free to do everything to whom it is assigned. And be healthy!

How can you not allow such an analysis to be carried out when it comes to establishing such a serious illness in a child as meningitis! There is no longer a choice, especially given the current outbreak of the disease. In the majority of 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 with us 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 corpse of a one-year-old girl was brought to the hospital, yesterday the parents refused hospitalization, and today they simply did not have time to take it. Of course, a puncture is a procedure that God forbid anyone to experience, but if it concerns life and health, there should be no doubt.

Good day! Vera, in which city are you lying, and where is the flash? My child and I are also in the hospital now with meningitis, we are already recovering! The puncture was already taken 3 times. There are no more options anyway! And this is a very revealing analysis! Before discharge, they will take it again! The main thing is that everything turns out to be normal!

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

How often can this procedure be performed?

And how do you feel about the fact that this procedure will be done by a trainee and after a while you will have back problems.

Not a single doctor admits his mistake, if something, moreover, with each intervention from the clinic, we are obliged to sign a consent to this, thereby removing all responsibility from the clinic if something goes wrong, but prove that you are not a camel, this is our free Soviet medicine.

They said, if there is a choice between putting the child in a coffin with meningitis or a risky puncture by your standards, which one will you choose?

On March 7, my son had a puncture, after the puncture he was sent to the ward, he was not told that he had to lie down, he was on his feet, sat. After 2 days, they said that the diagnosis of meningitis was not confirmed and we took him out of the infection. In the evening at home, in a sitting and standing position, his head and back began to hurt, and when he was lying down, the pain disappears. 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 plenty of fluids to produce cerebrospinal fluid, for an adult 4 liters, for a child - ask a doctor.

It is believed that in the course of days should pass, i.e. the hole will overgrow and the volume of licor will be replenished.

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What you need to know about spinal cord puncture

Lumbar puncture of the spinal cord is performed at the lumbar level of the spinal column. During the operation, a needle is inserted between several vertebrae of the lumbar ridge to obtain a sample of cerebrospinal fluid. This is required for anesthetic or therapeutic purposes, that is, when anesthesia of the area is required or any medical procedures are performed.

Thanks to bone marrow puncture, it is possible to detect:

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

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

What is required for

1. The need for spinal cord fluid for the examination.
2. Elucidation of the pressure indicator in the fluid of the spinal cord.
3. Cisternography and myelography.
4. Administration of a chemotherapeutic drug and drug solution.

The patient is injected by means of an injection with pigment solutions or radioactive compounds to obtain a clear display of the fluid stream.

The analysis results provide the ability to detect:

1. Dangerous microbes, fungal and viral infections, in particular syphilis, meningitis and encephalitis.
2. Hemorrhage in the subarachnoid cerebral space (SAH).
3. Certain types of cancer that occur in the spinal cord and brain.
4. Most of the inflammation of the central nervous system, for example, multiple sclerosis, acute polyradiculitis and various paralysis.

Consequences and risks

Bone marrow puncture is a rather dangerous undertaking. Its correct taking is carried out only by a qualified doctor who has specialized tools and deep knowledge.

The negative consequences and complications are:

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 recommended that during the first few days after the puncture, maintaining a sedentary lifestyle and adherence to bed rest.

Regarding the appearance of persistent pain in the spine, this is a fairly frequent discomfort 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 applied in case of suspicion or detection of brain dislocation, as well as in the presence of stem symptoms.

If the picore pressure in the spiral volume falls, then the puncture is not done, 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 is taken if the procedure is performed in case of impaired blood clotting, a tendency to bleeding, as well as taking medications that thin the blood. These include:

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

How is the procedure performed

A puncture of the spinal cord is performed in a polyclinic or in a hospital setting. Before the procedure, the patient's back is washed with an antiseptic soap, disinfected with alcohol or iodine, and then covered with a sterile napkin. The puncture site must be decontaminated with an effective anesthetic.

This procedure is done between the 3rd and 4th or 4th and 5th vertebrae. The curve that outlines the apex of the iliac vertebral bone serves as a reference point for the interspinous gap.

The patient is placed in a horizontal position on the right or left side. Thus, he must lie 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 through the introduction of 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 a cm and a thickness of 0.5-1 mm. The needle is inserted strictly in the sagittal plane and is directed somewhat upward, that is, in accordance with the tile-like location of the spinous formation.

The needle, as it approaches the intrathecal space, will experience resistance from the fact that it comes into contact with the medulla and yellow ligament, easily overcomes the layer of fatty tissue and meets resistance when the strong meninges passes.

When punctured, the doctor and patient feel as if a needle is falling through. This phenomenon is quite normal, do not be afraid. The needle moves along a few millimeters and the mandrel is removed from it. After that, cerebrospinal fluid should begin to flow out of the needle. In the normal state, the liquid is transparent and flows out in scanty drops. Modern pressure gauges 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 an infringement of the trunk and dislocation of the brain.

After the pressure has been determined and the cerebrospinal fluid is taken, the needle is removed, and the puncture area is sealed with a sterile pad. Cerebrospinal fluid is taken for about 45 minutes. The patient after the puncture should be in bed for at least a day.

What happens after

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

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

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

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

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

If the protein exceeds the normal value, then this may indicate poor health of the patient, as well as that inflammation has begun to develop. In the event that the indicator of 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 normal sample contains no more than 5 mononuclear leukocytes. If their number grows, then this indicates the presence of infection.

Pay attention to the glucose concentration. Due to the low sugar level in the sample taken, the presence of infection and other pathological processes is confirmed.

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

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

Lumbar puncture: when it is carried out, the course of the procedure, transcript, consequences

Lumbar puncture is the most important diagnostic method for a number of neurological and infectious diseases, as well as one of the ways of administering drugs and anesthetics. The use of modern research methods, such as CT and MRI, has reduced the number of punctures performed, but specialists cannot yet completely abandon it.

Patients sometimes mistakenly refer to the procedure for collecting cerebrospinal fluid as a spinal cord puncture, although the nerve tissue should in no case be damaged or get into the puncture needle. If this happened, then we are talking about a violation of technology and a gross error of 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 in the ventricular system, providing trophism of the nervous tissue, support and protection of the brain and spinal cord. With pathology, its amount can increase, provoking an increase in pressure in the cranium, infections are accompanied by a change in the cellular composition, with 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 establish the correct diagnosis, and therapeutic, if drugs are injected into the subarachnoid space. Increasingly, puncture is used to provide anesthesia for abdominal and pelvic surgery.

As with any invasive intervention, the puncture of the "spinal cord" has a clear list of indications and contraindications, without which it is impossible to ensure the patient's safety during and after the procedure. It's not just that such an intervention is prescribed, but it is also not necessary to panic prematurely if the doctor considers it necessary.

When can and why can not a lumbar puncture be done?

Indications for lumbar puncture are:

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

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

With an increase in intracranial pressure, spinal cord puncture is considered almost the only way to remove excess fluid and save the patient from many unpleasant symptoms and complications.

The introduction of anticancer agents directly under the cerebral membranes significantly increases their concentration in the focus of neoplastic growth, which makes it possible not only to more actively influence tumor cells, but also to use a higher dosage of drugs.

Thus, the cerebrospinal fluid is taken to determine its cellular composition, the presence of pathogens, blood impurities, the detection of tumor cells and the measurement of the pressure of the cerebrospinal fluid in the pathways of its circulation, and the puncture itself is carried out with the introduction of drugs or anesthetics.

With a certain pathology, the puncture can cause significant harm and even cause the death of the patient, therefore, before its appointment, possible obstacles and risks are necessarily excluded.

Contraindications to lumbar puncture include:

1. Signs or suspicion of dislocation of brain structures during its edema, neoplasm, hemorrhage - a decrease in cerebrospinal fluid pressure will accelerate the penetration of the stem sections and can cause death of the patient right during the procedure;
2. Hydrocephalus caused by mechanical obstacles to the movement of cerebrospinal fluid (adhesions after infections, operations, congenital defects);
3. Blood clotting disorders;
4. Purulent and inflammatory skin processes 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 of preoperative preparation. As before any invasive procedure, the patient will have to undergo blood and urine tests, undergo a study of the blood coagulation system, CT, MRI.

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

Women who are planned to have a cerebrospinal fluid puncture and, especially, with X-ray contrast studies, should be sure that there is no pregnancy in order to exclude a negative effect on the fetus.

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

In children, the reason for a lumbar puncture can be the same diseases as in adults, but most often it is 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 research is necessary for recovery.

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

Lumbar puncture technique

To carry out the puncture of the cerebrospinal fluid, the examinee is placed on a hard table on the right side, the lower limbs are raised to the abdominal wall and clasped with hands. It is possible to perform a 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 the spinal tissue, no higher than the third.

The lumbar puncture technique is not difficult for a trained and experienced practitioner, and careful adherence to it helps to avoid serious complications. Puncture of the cerebrospinal fluid includes several successive stages:

• Preparatory - a sterile needle with a mandrel, containers for collecting liquor, 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 additionally bends the patient's spine and fixes it in this position;
• The nurse assisting with the operation lubricates the lumbar needle insertion site, starting from the puncture point and to the periphery, twice with iodine, then three times with ethanol to remove the iodine;
• The surgeon probes the puncture site, determines the iliac crest, mentally draws from it a perpendicular line to the spine, which falls between the 3 and 4 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 with the help of 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 skin surface, then gently, slightly tilting it towards the patient's head, is advanced inward, while the doctor will feel three needle failures - after puncturing the skin, intervertebral ligament and the hard membrane of the spinal cord;
• The third failure indicates that the needle has penetrated into the subshell space, after which the mandrel is removed. At this moment, cerebrospinal fluid may be released, and if it is not there, then the needle is inserted deeper, but very carefully and slowly due to the proximity of the choroid plexus and the risk of bleeding;
• At the moment the needle is in the canal of the spinal cord, the cerebrospinal fluid pressure is measured - using a special manometer or visually, according to the intensity of the flow of cerebrospinal fluid (normally up to 60 drops per minute);
• Actually taking the spinal punctate in 2 test tubes: put 2 ml of liquid for bacteriological analysis in a sterile one, in the second - the cerebrospinal fluid sent for the analysis of the cellular composition, the level of protein, 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 plaster.

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

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 analyzes. During the puncture, soreness at the puncture site is possible, therefore, pain relief and the introduction of sedatives are indicated for especially sensitive patients.

During the entire manipulation, it is important to maintain maximum immobility, therefore, the doctor's assistant holds the adults in the desired position, and the child is held by one of the parents, who also helps the baby to calm down. In children, anesthesia is mandatory and allows you to provide peace of mind to the patient, and the doctor gives the opportunity to act carefully and slowly.

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

Postoperative period and possible complications

After taking the cerebrospinal fluid, the patient is not lifted, but delivered 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 the 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 close medical supervision, every quarter of an hour, specialists monitor his condition, since the flow of cerebrospinal fluid from the puncture hole can continue up to 6 hours. When signs of edema and dislocation of the brain departments appear, urgent measures are taken.

After a lumbar puncture, strict bed rest is required. If the cerebrospinal fluid values ​​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 lumbar puncture can provoke headache attacks, which can last for about a week. It is removed with analgesics, but in any case, with such a symptom, you should talk to your doctor.

The collection of cerebrospinal fluid for research can be associated with certain risks, and if the puncture algorithm is violated, an insufficiently thorough assessment of indications and contraindications, and a severe general condition of the patient, the likelihood of complications increases. The most likely, albeit rare, complications of a lumbar 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, impaired sensitivity in case of trauma to the spinal cord root;
3. Post-puncture cholesteatoma, when epithelial cells enter the spinal cord canal (when using low-quality instruments, the absence of a mandrel in the needles);
4. Hemorrhage with trauma to the venous plexus, including subarachnoid;
5. Infection with subsequent inflammation of the soft membranes of the spinal cord or brain;
6. If antibacterial drugs or radiopaque substances get into the intrathecal space, symptoms of meningism with severe headache, nausea, vomiting.

The consequences after a properly performed lumbar puncture are rare. This procedure makes it possible to diagnose and effective treatment, and in case of hydrocephalus it is itself one of the stages in the fight against pathology. The danger of a puncture can be associated with a puncture, in which a skid of infection is possible, with damage to blood vessels and bleeding, as well as dysfunction of the brain or spinal cord. Thus, a lumbar 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 a lumbar puncture

The result of the cytological analysis of the cerebrospinal fluid is ready on the day of the study, and if necessary, bacteriological culture and assessment of the sensitivity of microbes to antibiotics, waiting for a response can take up to a week. This time is necessary for microbial cells to begin multiplying on nutrient media and to 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 not more than 330 mg per liter, the sugar level is about half that in the patient's blood. It is possible to find leukocytes in the cerebrospinal fluid, but in adults, up to 10 cells per μl is considered the norm, in children it is slightly higher, depending on age. The density is 1.005-1.008, the pH is 7.35-7.8.

An admixture of blood in the cerebrospinal fluid indicates hemorrhage under the lining 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 in red in all three samples, and in case of damage to the vessel, it brightens from 1 to 3 tubes.

The density of the cerebrospinal fluid also changes with pathology. So, in the case of an inflammatory reaction, it increases due to cellularity and the protein component, and with an excess of fluid (hydrocephalus), it decreases. Paralysis, brain damage from syphilis, 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 lining of the brain.

The biochemical composition of the cerebrospinal fluid also speaks of pathology. Sugar level decreases with meningitis, and rises with strokes, lactic acid and its derivatives increase in the case of meningococcal lesions, with 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, decrease with meningitis, syphilis.

According to the reviews of patients who have undergone a lumbar 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, carried out under local anesthesia, is painless. After a month after the diagnostic puncture, the patient can return to his usual way of life, if the result of the study does not require otherwise.

What is a spinal cord puncture, is it painful to do, possible complications

If we consider all the existing types of diagnostic studies, then one of the most difficult research methods is rightfully considered a puncture of the spinal cord. The sampling of fluid should be performed by a qualified surgeon, exclusively in a hospital.

What is a lumbar puncture

A spinal or lumbar puncture is a 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 that surrounds the spinal canal, that is used.

Why do spinal cord puncture?

A lumbar puncture is performed if there is a suspicion of the development of infectious diseases or oncological neoplasms. A diagnostic study is performed to confirm or clarify the diagnosis.

A puncture of the spinal cord is taken to measure the pressure in the spinal canal. The procedure can also inject a marker (with MRI or CT using contrast) or a drug.

Preparing for a lumbar puncture

Special preparation of the patient for the puncture of the cerebrospinal fluid is not required. It is enough to know about the presence of allergic reactions to pain medications. Local anesthesia is used during the procedure. Previously, the patient is given an allergy test and only after that they proceed to the procedure itself.

Does it hurt to take a spinal cord puncture?

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. The modern technique for carrying out the sampling procedure involves the use of local anesthesia.

How is a puncture taken

The patient is placed on a couch. The puncture site is injected with anesthetics. After the anesthesia has worked, go directly to the procedure itself:

• The patient is placed on a couch. The position of the patient during the lumbar puncture is as follows: the knees are pressed to the stomach, the chin to the chest. Anatomically, this position of the body leads to the spreading of the processes of the spine and the unhindered introduction of the needle.

After the procedure

It takes only a few minutes to draw up liquid for research. The patient after a lumbar puncture must be laid on a flat, hard surface. The patient is advised to remain immobile for the first two hours.

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

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

Why is a lumbar puncture dangerous?

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

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

Is it possible to replace a lumbar puncture with something?

The complex algorithm for the lumbar puncture and possible complications after the procedure have led to the fact that in European clinics this type of research is rarely used. But to clarify the diagnosis, a clinical study of the cerebrospinal fluid may be required, so it is unrealistic to completely do without this diagnostic procedure.

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A puncture of the spinal cord (lumbar puncture) is a type of diagnosis that is rather complicated. During the procedure, a small amount of cerebrospinal fluid is removed or drugs and other substances are injected into the lumbar spinal canal. In this process, the spinal cord is not directly touched. The risk that arises during puncture contributes to the rare use of the method exclusively in a hospital setting.

The purpose of a lumbar puncture

Spinal cord puncture is performed for:

Spinal puncture

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

With the help of a lumbar puncture, the following diseases are diagnosed:

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

Often a lumbar puncture is equated with a bone marrow biopsy, but this statement is not entirely correct. A biopsy takes a tissue sample for further research. The bone marrow is accessed through a sternum puncture. This method allows detecting bone marrow pathologies, some blood diseases (anemia, leukocytosis and others), as well as bone marrow metastases. In some cases, a biopsy may be performed while taking a puncture.

For the prevention and treatment of DISEASES OF THE JOINTS, our regular reader uses the increasingly popular method of NON-SURGICAL treatment recommended by leading German and Israeli orthopedists. After carefully reviewing it, we decided to offer it to your attention.

Indications for a spinal cord puncture

Mandatory puncture of the spinal cord is carried out for infectious diseases, hemorrhages, malignant neoplasms.

Take a puncture in some cases with relative indications:

inflammatory polyneuropathy; fever of unknown pathogenesis; demilienizing diseases (multiple sclerosis); systemic diseases of connective tissues.

Preparatory stage

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

A puncture of the spinal cord provides for the following preparation:

Writing a written consent to the manipulation. Taking blood tests to assess 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. Collecting information on the history of the disease, on recent and chronic pathological processes.

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

It is necessary to stop taking blood thinners, 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 need to be provided with information about the expected pregnancy. This information is necessary due to the alleged 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 be taken before your procedure.

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

Technique for performing the procedure

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

Spinal cord puncture

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

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

The specialist may use general anesthesia or use a local anesthetic. In some cases, a sedative drug may be used. Also during the procedure, heart rate, 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 the video image on the monitor and monitor the manipulation process.

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

CSF samples are sent for laboratory research, where histology takes place directly.

Spinal CSF

The doctor begins to draw conclusions on the nature of the fluid output and its appearance. In a normal state, the cerebrospinal fluid is transparent and flows out one drop in 1 second.

At the end of the procedure, you must:

adherence to bed rest for 3 to 5 days on the recommendation of a doctor; finding the body in a horizontal position for at least three hours; getting rid of physical activity.

Pain medications can be used when the puncture site hurts.

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

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. The head may ache for several days; damage to the roots of the spinal cord; bleeding; intervertebral hernia; epidermoid cyst; meningeal reaction.

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

It is believed that a spinal tap can damage the spinal cord. It is erroneous, since the spinal cord is located higher than the lumbar spine, where the puncture is directly performed.

Contraindications to spinal cord puncture

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

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

In each individual case, the doctor must analyze in detail the risk of 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 have a spinal cord puncture, but also carry out the procedure with minimal risk to 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 your clothes? It seems to you that this will soon go away on its own, but the pains only intensify ... Many methods have been tried, but nothing helps ... And now you are ready to use any opportunity that will give you the long-awaited well-being!

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

Why is a spinal cord puncture taken?

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

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 push apart the processes of the vertebrae and facilitate the penetration of the needle. The place in the puncture area is disinfected first with iodine and then with alcohol. Then local anesthesia is performed with an anesthetic (most often novocaine). The anesthetic does not give complete anesthesia, so the patient must pre-tune in to some unpleasant sensations in order to remain completely immobile.

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 the introduction of the needle into the spinal canal, cerebrospinal fluid begins to flow out of it. Usually, the study requires about 10 ml of cerebrospinal fluid. Also, during the taking of a spinal cord puncture, the speed of its expiration is assessed. In a healthy person, cerebrospinal fluid is clear and colorless and flows out at a rate of about 1 drop per second. In the case of increased pressure, the speed of the liquid outflow 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 a puncture of the spinal cord

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

A number of patients, after having a spinal cord puncture, may experience nausea, migraine-like pain, pain in the spine, and lethargy. For such patients, the attending physician prescribes pain relievers and anti-inflammatory drugs.

If the puncture was carried out correctly, then it does not bear any negative consequences, and the unpleasant symptoms disappear rather quickly.

Why is a spinal cord puncture dangerous?

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

One of the most common myths is that a puncture can damage the spinal cord and cause paralysis. 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 concern about the risk of infection, but usually the puncture is performed under the most sterile conditions. The risk of infection in this case is approximately 1: 1000.

Possible complications after a spinal cord puncture 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 the puncture of the spinal cord is performed by a qualified doctor, the risk of it is minimal and does not exceed the risk of biopsy of any internal organ.

To date, many diagnostic methods have been invented that allow making accurate diagnoses to exclude other pathological processes. To identify most pathologies, it is enough to do a tomography (computer, magnetic resonance) or X-ray, but there are diseases for which you need to take CSF for analysis. It represents the 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 of execution, 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 in many types of surgery, for example, when removing a stone from the urinary tract or kidney.

Lumbar puncture in children is performed in a similar way, but in the case of them, you will have to work hard to force the child to lie in one place and not move. Only an experienced doctor should take up the procedure, because in the event of an incorrectly made fence, there will be consequences. If the procedure is successful, the complications are usually minimal and disappear in 2-3 days.

Purpose of CSF Collection

Indications and contraindications for lumbar puncture do not differ much from other procedures. According to the analysis of cerebrospinal fluid, it is possible to exclude or confirm the presence of a malignant tumor, infection and other similar diseases. The list of what a spinal cord puncture is used for includes the following pathological processes:

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

Take a puncture of the spinal cord in children and adults to accurately determine the pressure of the spinal canal. Sometimes the procedure is used to inject a special marker used for imaging with a contrast agent or to inject a medication.

Puncture of the cerebrospinal fluid is carried out for various forms of meningitis and other diseases caused by infections. It is also performed to determine the presence of oncological diseases, as well as hematomas and rupture of an aneurysm (protrusion of the vessel wall).

Contraindications

Sometimes it is forbidden to take liquor for analysis, since there is a possibility of harm to the patient. Basically, contraindications to lumbar puncture are as follows:

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

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

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

There are other contraindications for lumbar puncture, namely:

• Pregnancy;
• Pathologies that worsen blood clotting;
• Diseases of the skin in the area of ​​the puncture of the cerebrospinal fluid;
• The use of medicines 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 listed reasons, then taking a spinal cord puncture is not recommended. It is performed only in vital cases, but all possible complications are taken into account.

Preparing for the procedure

There are no special preparatory moments before lumbar puncture. It will be enough for the patient to study information about possible allergic reactions to the injection of an anesthetic drug and to make an allergy test immediately before the procedure. After such fairly simple steps, the doctor will proceed with the operation.

The only thing to consider is the psychological barrier. Many people do not understand why they need to additionally morally adjust themselves, but right during the procedure, some patients are very panicky. This is especially true for children with their fragile psyche. The specialist has to constantly twist 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. That is why there are so many bad rumors about the procedure, because earlier patients were greatly tormented when collecting cerebrospinal fluid and often there was a puncture of the spinal cord due to the patient's movements. Nowadays, the whole process takes place after the introduction of pain medications.

The procedure itself is virtually painless, but the patient feels discomfort during the puncture. For this reason, the doctor must without fail warn the patient to be patient and not move until everything is over. Otherwise, the needle may twitch and touch other fabrics.

Technique

With lumbar puncture, the technique is as follows:

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

Side effects after the end of the procedure

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

Among the side effects after the procedure are the following:

• Headache. The painful sensations in this case resemble a migraine and the patient is often nauseous. In such a situation, anti-inflammatory and analgesic drugs are used;
• General weakness. The patient feels tired and fatigued after the puncture, and sometimes paroxysmal pain is felt at the site of the puncture. This side effect occurs due to a lack of cerebrospinal fluid, which will recover 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 a spinal cord puncture is dangerous by looking at this list:

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

Lumbar puncture is a rather dangerous method of examination and an experienced doctor should undertake its implementation. It is advisable to make a puncture no more than once every six months, and after the procedure, bed rest must be observed.

Today, there are many techniques through which you can diagnose various diseases. One of them is a puncture of the spinal cord. Thanks to this procedure, it is possible to identify such dangerous diseases as meningitis, neurosyphilis, and cancerous tumors.

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 for the administration of drugs, 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.

Objectives and indications for the study

CSF (cerebrospinal fluid) is taken from the subarachnoid space, the spinal cord remains intact during the procedure. The study of the material makes it possible to obtain information about a particular disease, to prescribe the correct treatment.

Lumbar puncture goals:

• laboratory study of cerebrospinal fluid;
• reducing pressure in the brain and spinal cord by removing excess fluid;
• measurement of cerebrospinal fluid pressure;
• administration of drugs (analgesics, chemotherapy), 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 trauma;
• tumor formations;
• bleeding in the subarachnoid space;
• multiple sclerosis.

For therapeutic purposes, lumbar puncture is often used for herniated discs for the administration of drugs. Given the certain danger of the procedure for the patient, it is recommended to carry it out only in those cases when it is extremely necessary.

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Contraindications

The collection of cerebrospinal fluid is not carried out with large formations of the posterior fossa of the skull or the temporal region of the brain. Such a procedure for these pathologies can cause infringement of the brain stem in the opening of the occiput and lead to death.

You can not make a puncture if a person has purulent inflammation of the skin, spinal column at the site of the proposed puncture. There is a high risk of complications after the procedure with obvious deformities of the spine (kyphosis, scoliosis). It is very careful to carry out a puncture for problems with blood clotting, as well as for people taking certain drugs (Aspirin, Naproxen), anticoagulants (Warfarin, Clopidogrel).

There are no special preparatory measures before lumbar puncture. Before the procedure, patients pass allergy tests for the tolerance of the injected painkillers. Before sampling the cerebrospinal fluid, local anesthesia must be done.

Process of conducting

The patient lies on the side of the couch. The knees should be pressed against the stomach. Press the chin as close to the 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 Novocain) is injected. While the puncture is being performed, the patient should lie still. For the procedure, take a disposable sterile 6-cm needle, 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 the 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 clear, it flows out in 1 second in a volume of 1 ml. With increased pressure, this speed increases.

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

After the procedure

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

Immediately after taking the material, the patient may feel headaches that resemble migraines. They may be accompanied by nausea or vomiting. During the recovery of the body's lack of cerebrospinal fluid, attacks of lethargy and weakness occur. There may be pain in the puncture area.

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CSF study

When analyzing a liquid, its pressure is first evaluated. The norm in a sitting position is 300 mm. water Art., in the supine position - 100-200 mm. water Art. the pressure is estimated based on the number of drops per minute. If the pressure is increased, then this may indicate an inflammatory process of the central nervous system, the presence of tumors, hydrocephalus.

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

• immunological;
• bacteriological;
• physical and chemical.

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

The study of the concentration of proteins makes it possible to identify the inflammatory process in the body. A protein value of more than 45 mg / dL is an abnormality indicating the presence of an infection. An increase in the concentration of mononuclear leukocytes (the norm is up to 5 pieces) also indicates infection. Liquor is also tested for glucose concentration, detection of viruses, bacteria, fungi, detection of atypical cells.

Complications and possible consequences

Spinal cord puncture is a procedure that can be fraught with dangerous consequences. Therefore, it should only be carried out by a qualified specialist with extensive experience and deep 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 cord;
• massive hemorrhage due to increased load on the brain;
• damage to the spinal nerves from the needle can cause back pain;
• if the rules of antiseptics are violated, infection may occur, an inflammatory process or an abscess of the meninges may develop;
• infringement of the nerve center, and as a result - impaired respiratory function.

Failure to follow the rehabilitation rules after a lumbar puncture can also lead to serious complications.

In contact with

Lumbar puncture of the spinal cord (lumbar puncture, spinal, lumbar or spinal puncture) is performed in the lower back, in the region of the lumbar level of the spine. During surgery, a medical needle is inserted between the two lumbar bones of the spine (vertebrae) to either obtain a sample of cerebrospinal fluid, to numb the area for therapeutic or anesthetic purposes, or to administer treatment.

The procedure allows specialists to detect dangerous pathologies:

• meningitis;
• neurosyphilis;
• abscess;
• various disorders of the central nervous system;
• multiple demyelinating sclerosis;
• all kinds of brain and spinal cord cancer.

Sometimes doctors use a lumbar puncture to inject pain relievers during chemotherapy.

What is a puncture for?

• selection of cerebrospinal fluid for research;
• finding out the magnitude of the pressure in the cerebrospinal fluid;
• spinal anesthesia;
• the introduction of chemotherapy drugs and medicinal solutions;
• performing myelography and cisternography.

When puncture of the spinal cord for the listed procedures, the patient is injected with a pigment solution or a radioactive composition to obtain a clear display of the fluid stream.

The information collected during this procedure allows you to discover:

• dangerous microbial, viral and fungal infections, including encephalitis, syphilis and meningitis;
• hemorrhage in the subarachnoid space of the brain (SAH);
• some cancers that occur in the brain and spinal cord;
• most of the inflammatory conditions of the central nervous system, for example, multiple sclerosis, acute polyradiculitis, various paralysis.

Risks and consequences of a lumbar puncture

Lumbar puncture of the spine is a dangerous procedure. Only a qualified doctor with a special tool and deep knowledge can take a puncture correctly.

Manipulation of the spine can have negative consequences. They can lead to:

Where is the CSF needle going?

• headache;
• discomfort;
• bleeding;
• increased intracranial pressure;
• hernia formation;
• the development of cholesteatoma - a tumor-like formation containing dead epithelial cells and a mixture of other substances.

Quite often, patients experience severe headache after performing a lumbar puncture. The malaise occurs due to fluid leakage into closely spaced tissues.

Patients often notice headache while sitting and standing. It often goes away when the patient goes to bed. Taking into account the current picture, the attending physicians recommend that during the first 2-3 days after the operation, lead a sedentary lifestyle and observe bed rest.

Unrelenting spinal pain is a common discomfort experienced by patients undergoing a spinal cord puncture. The pain can be localized at the puncture site and spread down the back of the legs.

The main contraindications

Lumbar puncture of the spinal cord is categorically contraindicated in patients in whom dislocation of the brain is suspected or already identified, and the presence of stem symptoms is found.

A drop in cerebrospinal fluid pressure in the spinal volume (in the presence of an increased pressure focus) can have dangerous consequences. It can trigger the mechanisms of entrapment of the brain stem and thereby provoke the death of a patient in the operating room.

Special precautions should be taken when performing puncture in patients with bleeding disorders, people prone to bleeding, and those taking blood thinners (anticoagulants). These include:

• warfarin;
• clopidogrel;
• some commercial analgesics such as aspirin, ivalgin, or naproxen sodium.

How is the puncture performed?

Lumbar puncture can be performed in a polyclinic or in a hospital. Before the procedure, the patient's back is washed with an antiseptic soap, disinfected with alcohol or iodine and covered with a sterile napkin. The puncture site is disinfected with an effective anesthetic.

This puncture is done between the third and fourth or fourth and fifth spinous processes of the spine. The reference point for the interspinous gap is the curve that outlines the tops of the iliac bones of the spine.

Standard puncture site in the spine

The patient who will undergo the procedure is laid horizontally on a couch (on the left or right side). His bent legs are pressed to his stomach, and his head to his chest. The skin in the area of ​​the puncture is treated with iodine and alcohol. The puncture site is anesthetized by subcutaneous injection of a solution of novocaine.

During the period of anesthesia, the doctor punctures the intrathecal space with a medical needle with a mandrel 10-12 cm long and 0.5-1 mm thick. The doctor should insert the needle strictly in the sagittal plane and direct it somewhat upward (corresponding to the tiled location of the spinous formations).

The needle, as it approaches the intrathecal space, will experience resistance from the contact of the interspinous and yellow ligaments, it is easy to overcome the layers of epidural fatty tissue and meet resistance when passing through the strong meninges.

At the time of the puncture, the doctor and the patient may feel the needle falling through. This is quite normal and should not be feared. The needle should be advanced along the course by 1-2 mm and the mandrel should be removed from it. After removing the mandrel, CSF should flow out of the needle. Normally, the liquid should have a transparent color and flow out in scanty drops. To measure the pressure in the cerebrospinal fluid, modern manometers can be used.

Pulling the cerebrospinal fluid with a syringe is strictly prohibited, as this can lead to dislocation of the brain and pinching of the trunk.

After finding out the pressure and taking the cerebrospinal fluid, the syringe needle must be removed, the puncture area must be sealed with a sterile pad. The procedure takes approximately 45 minutes. A patient after a puncture must be in bed for at least 18 hours.

What happens after the procedure

Patients are prohibited from doing active and strenuous work on the day of the procedure. The patient can return to normal life only after the permission of the doctor.

A sample of fluid withdrawn by puncture is placed in a box and delivered to the laboratory for analysis. As a result of research activities, a laboratory assistant finds out:

• cerebrospinal fluid indicators;
• the concentration of protein in the sample;
• concentration of white blood cells;
• the presence of microorganisms;
• the existence of cancerous and disfigured cells in the sample.

What should be the indicators of cerebrospinal fluid? A good result is characterized by a clear, colorless liquid. If the specimen is dull, yellowish, or pinkish, this is evidence of infection.

The concentration of protein in the sample is studied (the presence of total protein and specific proteins). An increased protein content indicates poor health of the patient, the development of inflammatory processes. If the protein index is higher than 45 mg / dL, then infections and destructive processes may be present.

The concentration of white blood cells is important. The sample should normally contain up to 5 mononuclear leukocytes (white blood cells). An increase in the number of white blood cells indicates the presence of an infection.

Attention is drawn to the concentration of sugar (glucose). A low blood sugar level in the collected sample confirms the presence of infection or other pathological conditions.

Detection of microbes, viruses, fungi, or any microorganism indicates the development of an infection.

Finding cancerous, mutilated, or immature blood cells confirms the presence of some type of cancer.

Laboratory tests allow the doctor to establish an accurate diagnosis of the disease.

To examine a patient, specialists use various diagnostic methods. One of them is a puncture of the spinal cord, in another way it is called a lumbar puncture.

This is a serious and rather complicated process in which spinal cord fluid is taken. This procedure has some risks, and therefore it is used relatively rarely.

What is the procedure

The collection of cerebrospinal fluid is performed in order to confirm the alleged diagnosis or in order to identify concomitant complications. We propose to consider the most frequent situations requiring this procedure:

• infectious diseases of various kinds;
• inflammatory processes occurring in the spinal cord or in the brain;
• subarachnoid bleeding;
• the presence of bone seals;
• determination of the pressure of the spinal cord fluid;
• suspicion of a tumor.

What else is a spinal puncture done for? In addition to the situations that we have listed, the procedure can be carried out for medicinal purposes. For example, thanks to puncture, it is possible to administer drugs and thus relieve the patient of herniated discs.

A patient after a stroke can also undergo a puncture of the spine. This will help clarify the nature of the stroke.

However, before puncturing, the patient will be informed about the risk of the procedure, so it will only be carried out in the most extreme cases.

Technique

We examined why a puncture is taken from a vertebra, now we propose to find out exactly how this procedure is carried out:

• Puncture in the supine position. This position of the patient is most convenient for a specialist, therefore it is used much more often. The patient is placed on a hard surface on one side. He bends his legs to his stomach, presses his chin to his chest, and pulls in his stomach. This position allows you to stretch the spine as much as possible, which helps to achieve an increased distance between the vertebrae. Cerebrospinal fluid is collected in the presence of a nurse. There are situations when the doctor asks the nurse to fix the patient in the required position before the needle is inserted. This allows the specialist to be sure that the patient does not change his position from the unexpected sensation of a puncture with a needle. After the doctor inserts the needle, the patient can slowly change his position, but so that it does not interfere with the favorable course of the procedure.
• Puncture in a sitting position. The patient is seated on a gurney, while the patient must hold on to it with his hands. The nurse holds him, while she needs to monitor the patient's condition, taking into account his autonomic reaction.

Before carrying out the procedure, the doctor first palpates the puncture site, feeling for the necessary vertebrae and the distance between them. The alleged puncture site is treated with a 3% iodine solution and 70% ethanol solution. These funds are applied from the center to the periphery.

As for anesthesia, from 4 to 6 milliliters of a two percent solution of novocaine or another anesthetic, which is administered along the course of the future puncture, is sufficient here. It is worth noting that many doctors prefer lidocaine to collect spinal fluid.

Local anesthesia is also given to patients with deficits in consciousness. This is due to the fact that mild pain sensations can provoke an unwanted motor reaction.

Before performing the procedure, a specialist must check the site of the alleged puncture several times, and also make sure that the needle is in good working order. The stroke of the needle during the puncture of the intervertebral disc should resemble the position of the pen when writing.

For young children, guide the needle perpendicular to the punctured plane. As for adults, their needle is inserted with a slight slope, given the overhanging of the spinous vertebrae.

Possible complications

Any interference with the natural functioning of the body entails certain risks and can lead to various complications. Some patients complain that their spine hurts after a puncture. Often, patients note the following symptoms:

• nausea;
• headache;
• dizziness;
• vomit;
• general weakness.

Some experts are inclined to believe that two to three hours in the prone position is quite enough and after this time the patient can move freely. This will significantly reduce the risk of developing undesirable consequences.

It is also worth noting that some patients may experience severe pain. In such cases, your doctor will prescribe an effective pain reliever.

Another complication can be infection while taking spinal fluid. But if the procedure is carried out under sterile conditions, then there is practically no risk of infection.

Doctors often face the fear of patients that during the collection of cerebrospinal fluid, the spinal cord will be affected. We hasten to dispel these delusions. The puncture is taken in the lumbar spine, just below the spinal cord itself. In this regard, it is not possible to hurt him.

It is fair to say that today there are much less dangerous diagnostic methods than spinal cord puncture.

Therefore, if possible, doctors will use CT, MRI or ultrasound. But, unfortunately, there are diagnoses, for confirmation of which you only need to take a puncture. In this case, strictly follow all the doctor's recommendations and stay healthy!

Denial of responsibility

The information in the articles is for general information purposes only and should not be used for self-diagnosis of health problems or for therapeutic purposes. This article is not a substitute for medical advice from a physician (neurologist, therapist). Please see your doctor first to know the exact cause of your health problem.

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"Spinal surgery: disc implant Osteomyelitis of different parts of the spine: symptoms, treatment, consequences" All author's notes

Lumbar puncture ... It is also a spinal puncture, spinal puncture, lumbar puncture ... From the name it is clear that the intake of biological fluid (cerebrospinal fluid) with a special needle is carried out from the intervertebral space in the immediate vicinity of the spinal cord. The latter, with the correct conduct of the event, is not affected. The collected cerebrospinal fluid is examined for the content of certain proteins, elements, and foreign organisms. Let's take a closer look at the indications, contraindications for lumbar puncture, the procedure, a number of complications that it may entail.

What is this event?

So, a puncture of the spine is a collection of a small volume of specific cerebrospinal fluid. The latter washes not only the spinal cord, but also the brain. There are three main purposes of the procedure - analgesic, diagnostic and therapeutic.

Why do they take a puncture from the spine? The procedure is usually recommended for the following:

• Laboratory examination of collected cerebrospinal fluid. Helps to determine the nature of the pathological process.
• Determination of the pressure in the cerebrospinal fluid.
• Conducting spinal This method allows a number of surgical (surgical) interventions to be performed without general anesthesia, which is more harmful to the body.
• The use of drugs, chemotherapy drugs, special solutions. In most cases, they are injected into the subarachnoid space to reduce spinal pressure.
• Cisternography, myelography.

Why do they take a puncture from the spine?

In most cases, such a study allows the doctor to confirm or deny the presence of a pathology of the brain or spinal cord in the patient.

For what diseases is a puncture taken from the spine? This is a suspicion of the following diseases (or control over their therapy, assessment of the patient's recovery):

• Infections affecting the central nervous system - encephalitis, meningitis, arachnoiditis, myelitis. Other diseases of the central nervous system of a fungal, viral, infectious nature.
• Damage to the brain, spinal cord, as a result of the development of syphilis, tuberculosis.
• Subarachnoid bleeding.
• Abscess of the organs of the central nervous system.
• Stroke - ischemic, hemorrhagic.
• Traumatic brain injury.
• Malignant and benign tumors affecting the spinal cord, brain, its membranes.
• Demyelinating pathologies of the nervous system. A common example is multiple sclerosis.
• Guienne-Barré Syndrome.
• Other diseases of a neurological nature.

Now it is clear to us for what purpose a puncture from the spine. Moving on to the next topic.

Contraindication to the procedure

Spinal puncture is an event that has a number of contraindications:

• Volumetric formations on the cranial posterior fossa or temporal lobe of the cerebral spheres of the brain. Even taking a minimal amount of lumbar fluid in this case is fraught with dislocation of brain structures, impingement of the brain stem in the space of the foramen magnum. For the patient, all this threatens with instant death.
• It is forbidden to carry out the procedure if the patient has purulent lesions of the skin, soft tissues or the spine itself at the site of the alleged puncture.
• Relative contraindications are pronounced deformities of the spinal column. These include scoliosis, kyphoscoliosis, etc. The procedure will be fraught with the development of complications.
• With caution, a puncture is prescribed for patients with poor blood clotting, as well as for patients taking drugs that affect the rheology of the blood. These are anti-inflammatory nonsteroidal drugs, antiplatelet agents, anticoagulants.

Diagnostic preparation of the patient for the event

Before the puncture of the spine, the following examinations are necessary:

• Delivery of urine and blood for analysis - biochemical and general clinical. Additionally, the quality of blood clotting is determined here.
• Examination and palpation of the lumbar spine. This allows you to detect deformities that may have complications after the procedure.

Before the procedure

Before puncture of the bone marrow from the spine, you must not eat for 12 hours and drink for 4 hours. This is all the preparation that is required of the patient.

Immediately before the event, he must also do the following:

Start of the event

Lumbar puncture can be taken both in the hospital and in the clinic. The procedure starts like this:

1. The patient's back is washed with antiseptic soap, disinfected with an alcohol solution or an iodine preparation, and then covered with a special napkin.
2. The person is laid on a couch - it must be placed horizontally on the right or left side.
3. The examinee needs to press his head to his chest, and bend his legs at the knees and pull them close to the stomach. He is no longer required to participate.
4. When puncturing the spine, it is important for the child to explain to the little patient that during the procedure, you need to remain calm and try not to move.
5. Next, the doctor is determined with the puncture site. It is done either between the third and fourth, or between the fourth and fifth spinous vertebral processes. The reference point for the required interspinous gap will be the curve outlining the apex of the ilium of the spine.
6. The selected puncture site is additionally treated with an effective antiseptic.
7. Further, for local anesthesia, the doctor gives the patient an injection of novocaine.

Lumbar puncture

Let's take a look at how a spinal puncture is done:

1. After novocaine begins to act, the doctor punctures the selected location with a special needle. Its length is 10-12 cm, thickness is 0.5-1 mm. It is inserted strictly in the sagittal plane, heading slightly upward.
2. On the way to the intrathecal space, there may be resistance from contact with the yellow and interspinous folds. The instrument passes through the fatty epidural tissue relatively easily. The next resistance is from the meninges.
3. The needle moves gradually - 1-2 mm.
4. Next, the doctor removes the mandrin from it. After it, the cerebrospinal fluid should flow out. Normally, it is transparent, comes in scanty drops.
5. The doctor measures the pressure in the cerebrospinal fluid with modern manometers.
6. It is strictly forbidden to draw out liquid with a syringe! This can lead to entrapment of the brain stem and its dislocation.

Completion of the procedure

After the fluid pressure is measured, the required volume of cerebrospinal fluid is taken for research, the needle is carefully removed. The puncture zone must be sealed with a sterile bandage.

In order not to provoke the negative consequences of a puncture of the spine, the patient must follow the following recommendations:

• Observe bed rest for 18 hours after the event.
• On the day of the procedure, give up active and strenuous activities.
• You should return to normal life (without a sparing regimen) only after permission from the treating doctor.
• Taking painkillers. They reduce the severity of discomfort at the puncture site, and fight headaches.

Feeling the patient

The whole procedure takes about 45 minutes. Spending all this time in the embryo's position, in an almost motionless position, is considered uncomfortable for many subjects.

Reviews of the spinal puncture also indicate that this is a somewhat painful procedure. Unpleasant sensations are noted at the time of needle insertion.

Research: measuring pressure

This is the very first study that is carried out directly during the collection of cerebrospinal fluid.

The assessment of the indicators is as follows:

• Normal seated pressure is 300 mm H2O.
• Normal pressure in the prone position is 100-200 mm H2O.

However, in this case, the assessment of pressure is indirect - by the number of drops flowing out in 1 minute. The normal value of the pressure of the cerebrospinal fluid in the spinal canal in this case is 60 drops / min.

An increase in this indicator indicates the following:

• Hydrocephalus.
• Water stagnation.
• Various tumor formations.
• Inflammation affecting the central nervous system.

Laboratory research

Further, the cerebrospinal fluid is collected by the doctor in two 5 ml tubes. The liquid is sent to the laboratory for the necessary research - bacterioscopic, physicochemical, bacteriological, PCP-diagnostic, immunological, etc.

Among other things, when analyzing a biomaterial, a laboratory assistant must identify the following:

• Protein concentration in a CSF sample.
• Concentration in the mass of white blood cells.
• The presence and absence of certain microorganisms.
• The presence of abnormal, deformed, cancerous cells in the sample.
• Other indicators characteristic of cerebrospinal fluid.

Normal indicators and deviations from them

Of course, it is impossible for a layman to correctly analyze a CSF sample. Therefore, here is a general introduction to his research:

• Colour. Normally, the liquid is transparent and colorless. A pinkish, yellowish tint, dullness indicate the development of an infection.
• Protein - general and specific. Increased values ​​(more than 45 mg / dl) indicate poor health of the patient, infections, destructive and inflammatory processes.
• White blood cells. The norm is no more than 5 mononuclear leukocytes. If there are more of them in the analysis results, then this fact can also indicate the development of an infection.
• Concentration of glucose. Low sugar values ​​in the bio-sample also indicate pathological processes.
• The detection of certain bacteria, fungi, viruses, and other organisms in the cerebrospinal fluid indicates a corresponding infection.
• Immature, deformed, cancer cells in the sample indicate the development of cancer.

Complications after the procedure

The consequences of a puncture of the spine can be as follows:

• Infection. It is caught when the medical staff violates antiseptic discipline. It can manifest itself as an inflammation of the meninges, the development of abscesses. In this case, emergency antibiotic therapy is needed to prevent death.
• Dislocation complication. The consequence of a drop in cerebrospinal fluid pressure is possible with space-occupying lesions in the cranial posterior fossa. Therefore, before the puncture, it is additionally necessary to conduct a REG, EEG.
• Hemorrhagic complications. The consequence of damage to large blood vessels during careless carrying out of the procedure. Hematomas and bleeding may occur. Requires urgent medical attention.
• Traumatic complication. An incorrect puncture can lead to damage to the intervertebral discs, nerve spinal roots. For the patient, this is reflected by back pain.
• Headache. Since intracranial pressure drops when a CSF sample is taken, this is reflected on the patient by a aching, squeezing headache. The symptom goes away on its own after rest, sleep. However, if the headache does not subside within a week, this is a reason for an urgent visit to the doctor.

Now you know how a lumbar puncture is performed. We also examined the contraindications, indications for it, the complications that the procedure faces.

A puncture of the spinal cord (lumbar puncture) is a type of diagnosis that is rather complicated. During the procedure, a small amount of cerebrospinal fluid is removed or drugs and other substances are injected into the lumbar spinal canal. In this process, the spinal cord is not directly touched. The risk that arises during puncture contributes to the rare use of the method exclusively in a hospital setting.

The purpose of a lumbar puncture

Spinal cord puncture is performed for:

Spinal puncture

• taking a small amount of cerebrospinal fluid (cerebrospinal fluid). In the future, their histology is carried out;
• measuring the pressure of the cerebrospinal fluid in the spinal canal;
• removing excess cerebrospinal fluid;
• the introduction of drugs into the spinal canal;
• facilitating difficult labor in order to prevent pain shock, as well as anesthesia before surgery;
• determining the nature of the stroke;
• isolation of tumor markers;
• carrying out cisternography and myelography.

With the help of a lumbar puncture, the following diseases are diagnosed:

• bacterial, fungal and viral infections (meningitis, encephalitis, syphilis, arachnoiditis);
• subarachnoid bleeding (hemorrhage in the region of 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.

Often a lumbar puncture is equated with a bone marrow biopsy, but this statement is not entirely correct. A biopsy takes a tissue sample for further research. The bone marrow is accessed through a sternum puncture. This method allows detecting bone marrow pathologies, some blood diseases (anemia, leukocytosis and others), as well as bone marrow metastases. In some cases, a biopsy may be performed while taking a puncture.

For the prevention and treatment of DISEASES OF THE JOINTS, our regular reader uses the increasingly popular method of NON-SURGICAL treatment recommended by leading German and Israeli orthopedists. After carefully reviewing it, we decided to offer it to your attention.

Indications for a spinal cord puncture

Mandatory puncture of the spinal cord is carried out for infectious diseases, hemorrhages, malignant neoplasms.

Inflammatory polyneuropathy

Take a puncture in some cases with relative indications:

• inflammatory polyneuropathy;
• fever of unknown pathogenesis;
• demilienizing diseases (multiple sclerosis);
• systemic diseases of the connective tissues.

Preparatory stage

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

A puncture of the spinal cord provides for the following preparation:

1. Writing a written consent to carry out the manipulation.
2. Delivery of blood tests, with the help of which its coagulability is assessed, as well as the work 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 history of the disease, on recent and chronic pathological processes.

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

It is necessary to stop taking blood thinners, 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 need to be provided with information about the expected pregnancy. This information is necessary due to the alleged 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 be taken before your procedure.

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

Technique for performing the procedure

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

Spinal cord puncture

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

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

The specialist may use general anesthesia or use a local anesthetic. In some cases, a sedative drug may be used. Also during the procedure, heart rate, 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 the video image on the monitor and monitor the manipulation process.

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

CSF samples are sent for laboratory research, where histology takes place directly.

Spinal CSF

The doctor begins to draw conclusions on the nature of the fluid output and its appearance. In a normal state, the cerebrospinal fluid is transparent and flows out one drop in 1 second.

At the end of the procedure, you must:

• adherence to bed rest for 3 to 5 days on the recommendation of a doctor;
• finding the body in a horizontal position for at least three hours;
• getting rid of physical activity.

Pain medications can be used when the puncture site hurts.

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

Intervertebral hernia

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

It is believed that a spinal tap can damage the spinal cord. It is erroneous, since the spinal cord is located higher than the lumbar spine, where the puncture is directly performed.

Contraindications to spinal cord puncture

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

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

In each individual case, the doctor must analyze in detail the risk of 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 have a spinal cord puncture, but also carry out the procedure with minimal risk to the patient's health.

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

• Are you sedentary?
• You can't boast of a royal posture and are trying to hide your stoop under your clothes?
• It seems to you that it will soon go away on its own, but the pains only intensify ...
• 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 good health!

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

Why is a spinal cord puncture taken?

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

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 push apart the processes of the vertebrae and facilitate the penetration of the needle. The place in the puncture area is disinfected first with iodine and then with alcohol. Then local anesthesia is performed with an anesthetic (most often novocaine). The anesthetic does not give complete anesthesia, so the patient must pre-tune in to some unpleasant sensations in order to remain completely immobile.

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 the introduction of the needle into the spinal canal, cerebrospinal fluid begins to flow out of it. Usually, the study requires about 10 ml of cerebrospinal fluid. Also, during the taking of a spinal cord puncture, the speed of its expiration is assessed. In a healthy person, cerebrospinal fluid is clear and colorless and flows out at a rate of about 1 drop per second. In the case of increased pressure, the speed of the liquid outflow 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 a puncture of the spinal cord

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

A number of patients, after having a spinal cord puncture, may experience nausea, migraine-like pain, pain in the spine, and lethargy. For such patients, the attending physician prescribes pain relievers and anti-inflammatory drugs.

If the puncture was carried out correctly, then it does not bear any negative consequences, and the unpleasant symptoms disappear rather quickly.

Why is a spinal cord puncture dangerous?

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

One of the most common myths is that a puncture can damage the spinal cord and cause paralysis. 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 concern about the risk of infection, but usually the puncture is performed under the most sterile conditions. The risk of infection in this case is approximately 1: 1000.

Possible complications after a spinal cord puncture 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 the puncture of the spinal cord is performed by a qualified doctor, the risk of it is minimal and does not exceed the risk of biopsy of any internal organ.