Puncture of the spine: purpose, features, possible consequences

2024 Author: Curtis Blomfield | [email protected]. Last modified: 2023-12-16 20:44

Lumbar puncture… It is also a spinal puncture, spinal, spinal, spinal cord, lumbar puncture… From the name it is clear that biological fluid (liquor) is taken with a special needle from the intervertebral space in the immediate vicinity of the spinal cord. The latter, if the event is carried out correctly, is not affected. The collected cerebrospinal fluid is examined for the content of certain proteins, elements, 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 event is this?

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

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

Laboratory examination of the collected cerebrospinal fluid. Helps to determine the nature of the pathological process.
Determination of the pressure in the CSF.
Conducting spinal anesthesia (anesthesia). This method allows you to carry out a number of surgical (surgical) interventions 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 refute the presence of a pathology in the patient's brain or spinal cord.

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 central nervous system.
Stroke - ischemic, hemorrhagic.
Tranio-cerebral injuries.
Malignant and benign tumors affecting the spinal cord, brain, its membranes.
Demyelinating pathologies of the nervous system. A common example ismultiple sclerosis.
Guyenne-Barré syndrome.
Other neurological diseases.

Now it is clear to us for what purpose a puncture from the spine. Let's move on to the next topic.

Contraindication to the procedure

Puncture of the spine is an event that has a number of contraindications:

Sizable formations on the cranial posterior fossa or temporal lobe of the cerebral spheres. Even taking a minimal amount of lumbar fluid in this case is fraught with dislocation of brain structures, infringement of the brain stem in the space of the foramen magnum. For the patient, all this threatens with an instant lethal outcome.
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 - pronounced deformities of the spinal column. These include scoliosis, kyphoscoliosis, etc. The procedure will be fraught with the development of complications.
With caution, puncture is prescribed to patients with poor blood clotting, as well as to patients taking drugs that affect blood rheology. These are anti-inflammatory nonsteroidal drugs, antiplatelet agents, anticoagulants.

Diagnostic preparation of the patient for the event

The following examinations are required before a spinal puncture:

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

Before procedure

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

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

Tell the specialist in detail about all currently or recently taken medications. Particular attention is paid to those that somehow affect blood coagulation - heparin, aspirin, clopidogrel, warfarin, anticoagulants, non-steroidal anti-inflammatory drugs, antiplatelet agents.
Tell your doctor about all your history of allergic reactions. Especially for medicines, contrast agents and antiseptics.
The specialist should be aware of the patient's recent acute illnesses, as well as chronic pathologies.
The woman additionally informs the doctor about the probable pregnancy.

for what diseases take a puncture from the spine

Start of event

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

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.
The person is laid on the couch - he must be placed horizontally on the right or left side.
To the subjectit is necessary to press the head to the chest, and bend the legs at the knees and pull them close to the stomach. He is no longer required to participate.
When puncturing a child's spine, it is important to explain to a small patient that during the procedure you need to remain calm and try not to move.
Next, the doctor determines the puncture site. It is made either between the third and fourth, or between the fourth and fifth spinous vertebral processes. The reference point for the required interspinous space will be the curve that outlines the vertices of the ilium of the spine.
The selected puncture site is additionally treated with an effective antiseptic.
Next, for local anesthesia, the doctor gives the patient an injection of novocaine.

Preparatory part completed - next the main procedure.

Performing a lumbar puncture

Let's see how a spinal puncture is done:

After novocaine begins its action, the doctor performs a puncture of the selected location with a special needle. Its length is 10-12 cm, thickness is 0.5-1 mm. It is introduced strictly in the sagittal plane, heading slightly upwards.
On the way to the hypothecal space, there may be resistance from contact with the yellow and interspinous folds. Relatively easily, the instrument passes fatty epidural tissue. The next resistance comes from the tough meninges.
The needle advances gradually - by 1-2 mm.
Next, the doctor removes the mandrin from her. After it, the liquor should flow. Normally, it is transparent, comes in meager drops.
The doctor measures the pressure in the cerebrospinal fluid with modern manometers.
Drawing out liquid with a syringe is strictly prohibited! This can lead to infringement of the brain stem and its dislocation.

Completion of procedure

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

Recommendations for the patient after the puncture

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

Remain in bed for 18 hours after the event.
On the day of the procedure, give up active and strenuous activities.
To normal life (without a sparing regimen) should be returned only after the permission of the attending doctor.
Taking painkillers. They reduce the severity of discomfort at the puncture site, fight headaches.

Patient sensation

The whole procedure takes about 45 minutes. Spending all this time in the fetal position, in a virtually immobile position, is considered uncomfortable for many subjects.

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

Research: pressure measurement

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

The assessment of indicators is as follows:

Normal sitting pressure is 300mm of water.
Normal pressure in the supine position is 100-200 mm of water column.

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

The increase in this indicator indicates the following:

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

Lab test

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

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

Protein concentration in CSF sample.
Concentration in mass of white blood cells.
Presence and absence of certain microorganisms.
Presence of abnormal, deformed, cancerous cells in the sample.
Other indicators specific to cerebrospinal fluid.

Normal indicators and deviations from them

Of course, it is impossible for a non-specialist to properly analyze a CSF sample. Therefore, we present a general introductory information about his research:

Color. Normally, the liquid is clear and colorless. Pinkish, yellowish hue, dullness indicate the development of infection.
Protein - general and specific. Elevated values (more than 45 mg / dl) indicate poor he alth 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 results of the analysis, then this fact may also indicate the development of the infection.
Glucose concentration. Low levels of sugar in the biosample also indicate pathological processes.
The detection of certain bacteria, fungi, viruses, and other organisms in the cerebrospinal fluid indicates a corresponding infection.
Immature, deformed, cancerous cells in the sample indicate the development of cancer.

Complications after the procedure

The consequences of spinal puncture may be as follows:

Infection. It falls when the medical staff violates antiseptic discipline. It can be manifested by 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 CSF pressure is possible with volumetric formations in the cranial posterior fossa. Therefore, before the puncture, it is additionally necessary to conduct REG, EEG.
Hemorrhagic complications. The consequence of damage to large blood vessels duringcareless procedure. Hematomas and bleeding may occur. Requires urgent medical attention.
Traumatic complication. Incorrect taking of the puncture can threaten damage to the intervertebral discs, nerve spinal roots. For the patient, this is reflected in back pain.
Headache. Since intracranial pressure drops when a CSF sample is taken, this is reflected in the patient with 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 an occasion for urgent medical attention.