Lumbar Puncture

Lumbar puncture

With a lumbar puncture, among other things, CSF (cerebrospinal fluid, cerebrospinal fluid) is removed for diagnostic purposes. This fluid is located in the four chambers of the brain (ventricles), in the central canal of the spinal cord and in the subarachnoid space. The lumbar puncture is carried out to clarify pathological processes that affect the brain and spinal cord as well as the meninges and spinal cord membranes - for example, to diagnose meningitis (meningitis). It is also used in the context of therapeutic measures, for example to administer medication. The area of the lumbar spine (lumbar subarachnoid space) is punctured, as the spinal cord is already divided into individual nerves and there is no longer any risk of injury in this regard…

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• When is a lumbar puncture necessary?
• What preparations are necessary?
• How does the lumbar puncture work?
• What are the side effects / complications?
• Whom can I ask?

When is a lumbar puncture necessary?

The lumbar puncture is required when diagnosing:

• Infections and inflammations (e.g. meningitis, meningoencephalitis, neuroborreliosis, brain abscess, other infectious and inflammatory diseases),
• Subarachnoid hemorrhage (a special type of acute cerebral hemorrhage after rupture or trauma),
• Tumor diseases (e.g. brain tumor, leukemia) and autoimmune diseases (e.g. multiple sclerosis).

Punctures are also made to measure the CSF pressure.

For therapeutic reasons, a puncture is performed to:

• Pressure relief (normal pressure hydrocephalus),
• Administration of drugs (anesthesia, pain therapy, chemotherapy).

More information on spinal anesthesia and epidural anesthesia.

What preparations are necessary?

The patient's state of health is clarified in advance of a planned intervention. Various examinations are carried out (e.g. physical examination, blood clotting, various other blood values, computed tomography (CT) if elevated intracranial pressure is suspected). Among other things, it is essential to collect the medical history (e.g. illnesses, taking medication such as blood-thinning medication, etc.). If you suffer from bleeding disorders, you should definitely tell the doctor. Before the planned lumbar puncture, the doctor will inform you about the procedure and how it will proceed. Open questions can be clarified.

How does the lumbar puncture work?

The puncture can be done while sitting, with the back arched and the neck bent. It may also be done lying on your side, with your legs drawn up and your back bent (e.g. when you are bedridden and to measure CSF pressure).

For the puncture as part of the diagnosis, the doctor localizes the puncture site and marks it. Punctures are made in the area of the spine of the lower back (lumbar spine). The area of skin is shaved if necessary. It is disinfected and the area covered with a sterile cover. The site may be anesthetized locally. The doctor works under sterile conditions in order to avoid the spread of germs into the spinal canal.

After the puncture needle (a specially made needle) has been carefully advanced and liquor escapes, it is collected in sterile tubes. At the end of the sampling, the needle is removed, the puncture area is disinfected and a sterile plaster is applied. Compression may be necessary. Bed rest may be prescribed after the puncture. The further examination of the liquor takes place in the laboratory.

What are the side effects / complications?

As with other examinations and treatments, a lumbar puncture can have undesirable consequences. Various measures aim to avoid this. Before the puncture, the doctor will inform you about the risks, necessity and benefits. People may be concerned about the idea of a puncture. However, the consequences of relevant illnesses that have not been clarified can be serious. The lumbar puncture is of great importance in the diagnosis of certain diseases and as a necessary measure in therapy.

The undesirable consequences include:

• Injuries to blood vessels from the needle and resulting bruises.
• Skin, tissue and nerve damage from the puncture - and possible consequences such as inflammation, back pain, paresthesia.
• Headache that can persist for several days, especially in an upright posture, but then disappears (post-puncture headache).
• Bleeding in the spinal canal is extremely rare. Hearing and visual disorders, bleeding under the meninges (subdural hematoma) and damage to the spinal cord nerves with permanent damage are also extremely rare.

Whom can I ask?

A lumbar puncture is usually performed as an inpatient in the hospital (anesthesia, internal medicine, neurosurgery, neurology), but it can also be performed on an outpatient basis. Depending on the situation, an admission or referral certificate from your treating doctor is required. For more information, see Well prepared for the hospital.