Lumbar Puncture Questions & Answers

Updated: Aug 02, 2018
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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Questions & Answers

Overview

Where is lumbar puncture (LP) most often performed?

Why is lumbar puncture (LP) performed?

What conditions are diagnosed based on cerebrospinal fluid (CSF) analysis obtained by lumbar puncture (LP)?

When should a lumbar puncture (LP) be performed?

How many moveable vertebrae are located in the lumbar spine?

What is the vertical height of the lumbar vertebrae?

What are the three functional parts of the lumbar vertebrae?

How are the lumbar vertebrae bodies distinguished from thoracic bodies in a lumbar puncture (LP)?

What are the heaviest components of the vertebrae?

How does the vertebral body increase its size?

Which vertebra has the heaviest body, smallest spinous process, and thickest transverse process?

Where can information about lumbar spine anatomy be found?

When is lumbar puncture (LP) indicated?

What are the absolute contraindications for a lumbar puncture (LP)?

What are the relative contraindications for lumbar puncture (LP)?

When is a brain CT scan indicated prior to performing a lumbar puncture (LP)?

When is a cranial CT scan indicated prior to performing a lumbar puncture (LP)?

How is the risk for complications of lumbar puncture (LP) reduced?

How is the risk of a post-lumbar puncture (LP) headache reduced?

Which needle size lowers the risk of a post-lumbar puncture (LP) headache?

How much is the incidence of post-lumbar puncture (LP) headaches reduced by use of atraumatic needles?

What is the benefit of prophylactic bed rest after a lumbar puncture (LP)?

Periprocedural Care

What items need to be included in a spinal or lumbar puncture (LP) tray?

What anesthesia is administered for a lumbar puncture (LP)?

How is the patient positioned during a lumbar puncture (LP)?

What is the best alternative position when performing a lumbar puncture (LP) in obese patients?

How is patient position changed during lumbar puncture (LP)?

Technique

What is the first step when performing a lumbar puncture (LP)?

What can be done to help open the interlaminar spaces during a lumbar puncture (LP)?

After interlaminar space has been opened, what are the subsequent steps prior to performing a lumbar puncture (LP)?

How should the surgical site be prepared for a lumbar puncture (LP)?

How should drapes be placed during a lumbar puncture (LP)?

What size syringe should be used to administer local anesthetic during a lumbar puncture (LP)?

What are the steps for administering local anesthesia prior to a lumbar puncture (LP)?

Which size syringe is most beneficial in administering local anesthesia prior to lumbar puncture (LP)?

How is the needle used as a guide during a lumbar puncture (LP)?

What are the steps for needle insertion during a lumbar puncture (LP)?

What angle and direction should the needle be inserted during a lumbar puncture (LP)?

How is measurement of the opening pressure taken during a lumbar puncture (LP)?

How much cerebrospinal fluid (CSF) should be collected during a lumbar puncture (LP)?

What are the final steps of a lumbar puncture (LP)?

What tests are performed once CSF has been collected in a lumbar puncture (LP)?

Are there universal protocols when performing studies on CSF tubes from a lumbar puncture (LP)?

What is the classic approach when sending CSF for testing following a lumbar puncture (LP)?

What is the approach when special CSF testing is indicated following a lumbar puncture (LP)?

Which tests may be conducted using cerebrospinal fluid (CSF) from a lumbar puncture (LP)?

How are specimens of CSF from lumbar puncture (LP) sent to the lab for centrifugation?

Which CSF findings from lumbar puncture suggest a specific infection?

What does a finding of WBCs and RBCs in CSF following lumbar puncture (LP) suggest?

When may multiple lumbar punctures (LPs) be indicated?

What is the indication for protein assessment of CSF from lumbar puncture (LP)?

What is the indication for glucose assessment of CSF from lumbar puncture (LP)?

What is suggested by xanthochromia in CSF from lumbar puncture (LP)?

What are possible complications of lumbar puncture (LP)?

What is the most common complication of a lumbar puncture (LP)?

How long do headaches persist after a lumbar puncture (LP)?

How are severe cases of post-lumbar puncture (LP) headaches treated?

What is the prevalence of RBC in CSF caused by lumbar puncture (LP)?

What should be done if a lumbar puncture (LP) results in a dry tap?

What are possible complications of a contaminated spinal needle during a lumbar puncture (LP)?

What can be done to minimize the risk of infections during a lumbar puncture (LP)?

What are rare complications of lumbar puncture (LP) in patients with coagulopathy?

When should a lumbar puncture (LP) be deferred?

What causes dysesthesia during lumbar puncture (LP)?

How can dysesthesia be prevented during a lumbar puncture (LP)?

What is the most serious complication of a lumbar puncture (LP)?

When should a lumbar puncture (LP) be avoided?

What studies are typically performed on the CSF from lumbar puncture (LP)?

Which specific studies are performed on CSF from a lumbar puncture (LP)?

How are cytologic studies of CSF from lumbar puncture (LP) used?

How is protein assessment of CSF from lumbar puncture (LP) used in the diagnosis of neurologic disease?

How is glucose assessment of CSF from lumbar puncture (LP) used in the diagnosis of infection?

Medications

What medications are used in a lumbar puncture (LP)?

Which medications in the drug class Local Anesthetics are used in the treatment of Lumbar Puncture?