Puncture of the spinal cord is a specific examination that is prescribed for pathologies of the central nervous system. It is carried out, as a rule, in a hospital and has its own contraindications. The article describes the description of the procedure, how to prepare for it, and what complications the patient can expect.
What is this?
Lumbar puncture is a type of complex diagnosis. You can also find other names: puncture of the subarachnoid space of the spinal cord, lumbar puncture, lumbar puncture.
During the procedure, the patient may have a cerebrospinal fluid sample taken, an anesthetic or a drug administered. The peculiarity is that during the manipulation the spinal cord itself is not affected, and the risks are due to the rarity of such a diagnosis.
When the procedure is performed, the patient is injected with a needle into the subarachnoid space of the spinal cord, this allows timely detection of dangerous pathologies.
Let's consider what a spinal puncture showsbrain:
- meningitis, encephalitis - inflammation that occurs in the lining of the brain and spinal cord or in the brain itself;
- neurosyphilis - bacterial brain damage;
- subarachnoid hemorrhage;
- pressure level in the spinal cord;
- multiple demyelinating sclerosis;
- Guillain-Barré-Stroll syndrome - an autoimmune pathology;
- cancer of the brain or spinal cord.
Also, lumbar puncture is used when administering chemotherapy or pain medications.
Purpose of the survey
Why do spinal cord puncture? The procedure is prescribed for diagnostic purposes to determine:
- biological features of CSF (histology);
- CSF pressure in the spinal canal;
- need to remove excess CSF;
- character stroke;
- presence of tumor markers.
Puncture can be performed for cisternography and myelography as a way to introduce a radiopaque substance.
Sometimes patients confuse the procedure of biopsy and puncture, believing that during the latter part of the bone marrow is taken. But it's not. With a lumbar puncture, the needle is not inserted into the spinal cord, the cerebrospinal fluid is taken from the cells before it. But for medical reasons, a biopsy can also be performed during the puncture.
Anesthesia and Needle Therapy
In addition to the examination, a puncture can be performed to administer painkillers,anesthesia or treatment of patients.
Spinal anesthesia is used for:
1. The need for anesthesia before operations on the bones or joints, as well as in spinal neurosurgery. It has its advantages:
- human consciousness is not completely turned off;
- fewer contraindications for patients with cardiorespiratory failure;
- easier recovery from anesthesia than general anesthesia.
2. Severe neurogenic or fatal pain, when the patient is not able to endure them, and general anesthesia is not available.
3. During childbirth, to alleviate the condition of the woman in labor.
Why is a spinal cord puncture done for therapeutic purposes?
Administration of drugs by puncture is recommended:
- In the presence of diseases of the spinal cord or brain. In such a situation, the blood-brain barrier prevents the effectiveness of intravenous drug administration. Encephalitis, meningitis, brain abscess are treated with epidural drugs.
- When a patient is severely injured and requires immediate treatment.
Indications
All indications for the appointment of spinal puncture are divided into absolute and relative. The first group includes diagnoses in which the procedure is mandatory, and the second - if a puncture is necessary as an additional examination measure.
To absolute indications include:
- suspected infectiousCNS disease;
- presence of malignant neoplasms located in the meninges;
- liquorrhea;
- suspected hemorrhage.
Relative readings include:
- diagnosis of multiple sclerosis and other demilienizing diseases;
- diseases with systemic damage to peripheral nerves that are of an inflammatory nature - polyneuropathies;
- diagnosis of septic vascular embolism;
- prolonged fever in children under 2 years of age;
- systemic connective tissue diseases.
Before the procedure, the doctor must pay attention to the exhaustion of the patient. In case of severe dehydration or spinal stenosis, manipulation may be difficult.
Contraindications
Sometimes a spinal tap can do more harm than good to a patient. Sometimes the procedure is life threatening.
In such cases, manipulation is not recommended:
- cerebral edema;
- a sharp increase in ICP;
- for occlusive hydrocephalus;
- diagnostics of mass formation in the brain cavity;
- with rashes or wounds on the body in the lumbar region, especially if they are accompanied by purulent compartments;
- in case of taking blood thinning medications;
- if the patient has a history of diseases of the blood coagulation system;
- hemorrhage that occurred due to a ruptured aneurysm;
- pregnancy;
- blockade of the subarachnoid space of the spinal cord.
The procedure involves the removal of a minimum amount of cerebrospinal fluid, so a thin needle is used. If the instrument diameter is not correct, there is a risk of expelling more CSF.
Puncture for children
Indications for the procedure for a child may be the same diseases as in adults. Infections or a diagnosis of malignancy are common.
Parents should be aware of how spinal cord puncture is done, the risks and contraindications of the procedure. As a rule, one of the parents is asked to be present during the manipulation and calm the child, explaining to him the need for this action.
Usually, the puncture is performed without general anesthesia using local anesthesia. If you have an allergy, for example, to novocaine, the procedure can be performed without anesthesia.
The puncture to the child is performed in the position of the body on its side, the legs are bent at the knees, the hips are pressed to the body. If the patient has scoliosis, then the procedure is carried out in a sitting position.
Preparation
Before preparing for the procedure, patients are interested in the question of whether spinal cord puncture is dangerous. If the manipulation is carried out correctly and without errors, then the patient is not in danger. A similar procedure is carried out only by qualified specialists in a hospital.
One of the dangerous complications of puncture isinfections and spinal cord injury. Milder effects may include bleeding and increased ICP.
To prepare for the puncture, the patient must:
- give written consent to the procedure;
- pass the necessary tests;
- do a CT or MRI as recommended by a doctor;
- tell the doctor about all medications the person is taking or has taken in the past month;
- tell about allergic manifestations and other conditions of the body, such as pregnancy;
- It is generally recommended to stop taking medication 2 weeks before your appointment;
- no water allowed for 12 hours before procedure;
- recommended the presence of a loved one during the manipulation.
Procedure in progress
Manipulation is performed in the ward or treatment room after the patient has emptied the bladder and changed into a hospital gown.
Next, a puncture is performed:
- In the side lying position, the patient bends his knees and presses them with his hands to his stomach.
- The man bends his neck and presses his head to his chest. For medical reasons, the puncture can be performed in a sitting position.
- The patient is asked not to move.
- The injection site is cleaned and lubricated with an antiseptic.
- Local anesthesia is administered. Sometimes the patient may need a sedative.
- An x-ray is connected, which will allow the specialist to control the insertion of the needle.
- A special needle is selectedfor puncture of the spinal cord - a reinforced design Beer needle with a stylet.
- A puncture is made between the 3rd and 4th or 4th and 5th vertebrae of the lumbar spine and the CSF is taken.
- After the end of the procedure, the needle is removed and a sterile dressing is applied.
- The patient lies on his stomach and is in this position for at least 3 hours.
If the puncture site hurts, pain medication may be prescribed.
After taking a CSF sample, the test tube is sent for analysis. During the puncture, the doctor determines the pressure of the CSF, it should be 60 drops per minute. If there is an inflammatory process, then the pressure increases.
What to do after the procedure
The consequences of a spinal cord puncture may occur if the doctor's recommendations are violated or the CSF collection procedure is incorrect.
Recommended for patient:
- Remaining in bed on the abdomen without a pillow for at least 3 hours after the puncture.
- It is forbidden to get up immediately after the procedure, otherwise CSF leakage may occur.
- For prevention, the doctor may recommend bed rest for several days.
- The patient is not allowed to lift weights.
- First time, the medical staff constantly checks the patient's condition.
- If the CSF analysis is normal, then the patient is allowed to get up 2-3 days after the manipulation.
Spinal tap: does it hurt?
All patients before the procedureinterested in a similar question. The doctor should explain that the puncture site will be anesthetized and the person will only feel pressure. The main thing before the puncture is to calm down and follow the recommendations of the neurosurgeon.
Reviews of patients about the procedure say that the fear of pain is greatly exaggerated. Manipulation is fast, the needle has a small diameter. There are discomfort during the sampling, but they do not look like acute pain. Patients report distant aching soreness.
In some cases, anesthesia is not used, for example, if you are allergic to novocaine. In this case, the pain will be unpleasant, but tolerable. It is important not to move, then there will be no complications.
Sometimes after the procedure, patients complain of headaches. As a rule, doctors prescribe painkillers.
CSF analysis
When performing spinal cord puncture, CSF is collected in 3 test tubes:
- The first one is for general analysis. The laboratory evaluates the density, color, pH, transparency of the CSF, determines the protein content and cytosis. Tumor and other types of cells may also be found.
- Second - for biochemical analysis. With the help of the study, the level of indicators such as glucose, lactate, chlorides is determined.
- Third - for microbiological analysis. A similar study is carried out to detect the pathogen. Fluid is cultured and antibiotic susceptibility is determined.
If a person is he althy, then his cerebrospinal fluid will be colorless and transparent. Darkening of the color indicates pathology: hemorrhage, jaundice, metastases,increase in protein. Turbidity appears with an increase in leukocytes, which may indicate a bacterial, viral or parasitic infection of the body.
If blood is found in the CSF
After the end of the puncture of the spinal cord, blood can be detected in the cerebrospinal fluid. To determine the cause of its impurity, all 3 tubes with CSF are evaluated.
There are two reasons for the anomaly:
- Possible damage to the vessel during the puncture. In this case, scarlet CSF will be present in one test tube, and CSF will become cleaner in the other two.
- Hemorrhage. In this case, the liquor in all test tubes will be the same scarlet color. With a small hemorrhage, the CSF may not be colored, but laboratory tests will reveal changes in it.
Consequences of the procedure
Complications of a spinal cord puncture are rare, affecting an average of 3 out of 1,000 patients.
Complications can be:
- Cholesteatoma can form - an epithelial tumor that appears from the introduction of subcutaneous epithelial cells with a needle.
- Headaches may appear during the week due to a decrease in the volume of circulating cerebrospinal fluid.
- If vessels or nerves were damaged during the procedure, then there may be: numbness and loss of sensation, pain, epidural abscess, hematoma.
- If asepsis rules are not followed, infectious diseases of the central nervous system may develop.
- If a spinal disc has been damaged, it mayappear intervertebral hernia.
The consequences are extremely rare. The procedure is not considered dangerous or risky if the algorithm of its implementation and asepsis rules are followed.
Spinal cord puncture is an important informative procedure that can significantly affect the effectiveness of treatment. It has its indications and limitations in carrying out. The need for manipulation is determined by the doctor after assessing all the risks and the patient's he alth status.
