Spinal cord puncture 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 contraindications. The article describes the procedure, how to prepare for it, and what complications a patient may expect.
What it is?
Lumbar puncture is a type of complex diagnosis. Other names can also be found: puncture of the subarachnoid space of the spinal cord, lumbar puncture, lumbar puncture.
During the procedure, a spinal fluid analysis may be taken from the patient, anesthesia or a drug may be administered. The peculiarity is that during 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, a needle is inserted into the patient's subarachnoid space of the spinal cord, this allows timely detection of dangerous pathologies.
Consider what the puncture of the spinal cord shows:
- meningitis, encephalitis - inflammation that occurs in the lining of the brain and spinal cord or in the brain itself;
- neurosyphilis - bacterial damage to the brain;
- subarachnoid hemorrhage;
- pressure level in the spinal cord;
- multiple demyelinating sclerosis;
- Guillain-Barré-Strohl syndrome - autoimmune pathology;
- brain or spinal cord cancer.
Also, lumbar puncture is used with the introduction of chemotherapy or pain medication.
The purpose of the survey
What is spinal cord puncture done for? The procedure is prescribed for diagnostic purposes to determine:
- biological features of cerebrospinal fluid (histology);
- CSF pressure in the spinal canal;
- the need to remove excess CSF;
- the nature of the stroke;
- the presence of tumor markers.
Puncture can be carried out for cisternography and myelography as a way of introducing a radiopaque substance.
Sometimes patients confuse the biopsy and puncture procedure, believing that during the latter a part of the bone marrow is taken. But this is not so. With lumbar puncture, the needle is not inserted into the spinal cord; cerebrospinal fluid located in the cells before it is taken. But for medical reasons, a biopsy can also be performed during a puncture.
Anesthesia and puncture therapy
In addition to the examination, puncture can be carried out with the aim of administering painkillers, anesthesia or treating patients.
Spinal anesthesia is used for:
1. The need for pain relief before surgery on 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 cardio-respiratory failure;
- a milder state when exiting anesthesia than with general anesthesia.
2. Severe neurogenic or fatal pain, when the patient is not able to tolerate them, and general anesthesia is not available.
3. During childbirth to alleviate the condition of the woman in childbirth.
Why do spinal cord puncture for therapeutic purposes?
The introduction of drugs using puncture is recommended:
- In the presence of diseases of the spinal cord or brain. In such a situation, the blood-brain barrier inhibits the effectiveness of intravenous medication. Encephalitis, meningitis, brain abscess is treated with epidural drugs.
- With severe injuries in the patient, when immediate exposure to drugs is required.
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 measure of examination.
The absolute indications include:
- suspected CNS infectious disease;
- the presence of malignant neoplasms located in the shells of the brain;
- liquorrhea;
- suspected hemorrhage.
Relative indications include:
- diagnosis of multiple sclerosis and other demilienizing diseases;
- diseases with systemic damage to the peripheral nerves, which are inflammatory in nature - polyneuropathy;
- diagnosis of septic vascular embolism;
- prolonged fever in children under the age of 2 years;
- systemic diseases of the connective tissue.
Before the procedure, the doctor always pays attention to the exhaustion of the patient. In the case of severe dehydration or spinal stenosis, manipulation can be difficult.
Contraindications
Sometimes a spinal puncture can do more harm to the patient than good. Sometimes the procedure is life threatening.
In such cases, manipulation is not recommended:
- cerebral edema;
- a sharp increase in ICP;
- with occlusive hydrocephalus;
- diagnosis of volumetric formation in the cavity of the brain;
- with rashes or wounds on the body in the lumbar region, especially if they are accompanied by purulent departments;
- in case of taking medications to thin the blood;
- in the presence of a patient’s history of blood coagulation system diseases;
- hemorrhage that occurred due to rupture of the 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 diameter of the tool is not selected correctly, then there is a risk of removing more CSF.
Puncture children
Indications for the procedure for a child may be the same diseases as in adults. Frequent cases are infections or the diagnosis of cancer.
Parents should be aware of how spinal puncture is done, about the risks and contraindications of the procedure. As a rule, one of the parents is asked to be present during the manipulation and to reassure the child, explaining to him the need for this action.
Typically, a puncture is performed without general anesthesia using local anesthesia. If you are allergic to, for example, novocaine, the procedure can be performed without pain relief.
Puncture of the child is performed in the body position on the 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 puncture is dangerous. If the manipulation is carried out correctly and without errors, then the patient is not in danger. Such a procedure is carried out only by qualified specialists in a hospital.
One of the dangerous complications of puncture is infection and spinal cord injury. The milder consequences may be the appearance of bleeding and an increase in ICP.
To prepare for a puncture, the patient must:
- give written consent to the procedure;
- pass the necessary tests;
- to have a CT scan or MRI scan as recommended by a doctor;
- inform the doctor about all drugs that a person takes or has taken over the past month;
- talk about allergic manifestations and other conditions of the body, for example, about pregnancy;
- cessation of medication is usually recommended 2 weeks before the scheduled examination;
- within 12 hours before the procedure is not allowed to drink water;
- recommended the presence of a close face during the manipulation.
Procedure Progress
Manipulation is carried out in a ward or treatment room after the patient empties the bladder and changes into hospital clothing.
Next, the puncture is performed:
- In the supine position, the patient bends his knees and presses his hands to his stomach.
- A 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 introduced. Sometimes a patient may need a sedative.
- An x-ray is connected, which will allow the specialist to control the introduction of the needle.
- A special needle for puncture of the spinal cord is selected - the Beer needle of reinforced construction with a stylet.
- A puncture is made between 3 and 4 or 4 and 5 vertebrae of the lumbar and a cerebrospinal fluid is taken.
- After 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, painkillers may be prescribed.
After taking a sample of cerebrospinal fluid, the 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 spinal puncture can occur if the doctor's recommendations are violated or the cerebrospinal fluid sampling procedure is incorrect.
The patient is recommended:
- Compliance with fixed bed rest 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 the cerebrospinal fluid may leak.
- For prevention, the doctor may recommend bed rest for several days.
- The patient is prohibited from lifting weights.
- At first, the medical staff constantly checks the patient's condition.
- If the cerebrospinal fluid analysis is normal, then the patient is allowed to get up 2-3 days after the manipulation.
Puncture of the spinal cord: does it hurt?
All patients are interested in a similar question before the procedure. The doctor must explain that the puncture site will be anesthetized and the person will feel only pressure. The main thing before the puncture is to calm down and follow the recommendations of the neurosurgeon.
Patient reviews of the procedure say that the fear of pain is greatly exaggerated. The manipulation is quick, the needle has a small diameter. There are unpleasant sensations during the analysis, but they do not look like acute pain. Patients noted distant aching soreness.
In some cases, anesthesia is not used, for example, with an allergy to novocaine. In this case, the pain will be unpleasant, but bearable. 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 conducting a puncture of the spinal cord, cerebrospinal fluid is collected in 3 tubes:
- The first 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 can also be found.
- The second is for biochemical analysis. With the help of the study, the level of such indicators as glucose, lactate, chlorides is determined.
- The third is for microbiological analysis. A similar study is conducted to detect the pathogen. Liquid is inoculated and antibiotic susceptibility is determined.
If a person is healthy, then his cerebrospinal fluid will be colorless and transparent. Darkening of the color indicates a pathology: hemorrhage, jaundice, metastases, increased protein. Turbidity appears with an increase in white blood cells, which may indicate a bacterial, viral or parasitic infection of the body.
If blood is found in the cerebrospinal fluid
After the puncture of the spinal cord is completed, blood can be detected in the cerebrospinal fluid. To determine the cause of its impurities, all 3 tubes with cerebrospinal fluid are evaluated.
There are two causes of the anomaly:
- Possible damage to the vessel during the puncture. In this case, the scarlet liquor will be present in one test tube, and in the other two CSFs will become cleaner.
- Hemorrhage. In this case, the cerebrospinal fluid in all test tubes will be equally scarlet. With a small hemorrhage, the cerebrospinal fluid may not be stained, but laboratory tests will reveal changes in it.
The consequences of the procedure
Complications of spinal puncture are a rare occurrence, which is observed on average in 3 out of 1000 patients.
Complications may include:
- A cholesteatoma can form - an epithelial tumor that appears from the introduction of subcutaneous epithelial cells with a needle.
- During the week, headaches may appear due to a decrease in the volume of circulating cerebrospinal fluid.
- If vessels or nerves were damaged during the procedure, then numbness and loss of sensation, pain, epidural abscess, hematoma can be observed.
- If you follow the rules of asepsis, infectious diseases of the central nervous system can develop.
- If the spinal disc has been damaged, an intervertebral hernia may appear.
The consequences are extremely rare. The procedure is not considered dangerous or risky subject to the algorithm of its implementation and the rules of asepsis.
Spinal cord puncture is an important informative procedure that can significantly affect the effectiveness of treatment. She has her testimony and limitations in conducting. The need for the appointment of manipulation is determined by the doctor after assessing all the risks and the patient’s health.