Puncture of the spine: purpose, features of the conduct, possible consequences

Lumbar puncture ... It is also a puncture of the spine, spinal, spinal, spinal cord, lumbar puncture ... From the name it is clear that the biological fluid (cerebrospinal fluid) is taken with a special needle from the intervertebral space in the immediate vicinity of the spinal cord. The latter, when properly conducted, is not affected. Collected cerebrospinal fluid is examined for the content of certain proteins, elements, and foreign organisms. Let's take a detailed look at the indications, contraindications for lumbar puncture, the procedure, a number of complications that it may entail.

What kind of event is this?

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

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

• Laboratory study of collected cerebrospinal fluid. Helps determine the nature of the pathological process.
• Determination of the pressure in the cerebrospinal fluid.
• Spinal anesthesia (anesthesia). This method allows a number of surgical (surgical) interventions to be performed without general anesthesia more harmful to the body.
• The use of drugs, chemotherapeutic drugs, special solutions. In most cases, they are introduced into the subarachnoid space to reduce the indicators of cerebrospinal pressure.
• Cisternography, myelography.

Why take a puncture from the spine?

In most cases, such a study allows the doctor to confirm or deny the presence of a pathology of the brain or spinal cord in the patient.

What diseases take a puncture from the spine? This is a suspicion of the following diseases (or monitoring their therapy, assessing 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 organs of the central nervous system.
• Stroke - ischemic, hemorrhagic.
• Traumatic brain injuries.
• Malignant and benign tumors affecting the spinal cord, brain, and its shell.
• Demyelinating pathologies of the nervous system. A common example is multiple sclerosis.
• Hyenna-Barre Syndrome.
• Other diseases of a neurological nature.

Now it is clear to us for what purpose the puncture from the spine. We proceed to the next topic.

Contraindication to the procedure

Spinal puncture - an event that has a number of contraindications:

• Volumetric 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 large occipital foramen. For the patient, this all threatens with instant death.
• 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, a puncture is prescribed for patients with poor blood coagulation, as well as for patients taking drugs that affect blood rheology. These are anti-inflammatory non-steroidal drugs, antiplatelet agents, anticoagulants.

Diagnostic preparation of the patient for the event

Before spinal puncture, the following examinations are required:

• The delivery of urine and blood for analysis is biochemical and general clinical. In addition, the quality of blood coagulability is determined here.
• Inspection and palpation of the lumbar spine. This allows you to detect deformations that can affect complications after the procedure.

Before the procedure

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

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

• Tell the specialist in detail about all current or recent medications. Particular attention is paid to the fact that they affect blood coagulation in any way - heparin, aspirin, clopidogrel, warfarin, anticoagulants, non-steroidal anti-inflammatory drugs, antiplatelet agents.
• Tell your doctor about all of your past allergic reactions. Especially for medicines, contrast agents and antiseptics.
• The specialist should be aware of acute illnesses recently suffered by the patient, as well as pathologies that are chronic in nature.
• The woman additionally informs the doctor about the probable pregnancy.
  

Event start

Lumbar puncture can be taken both in the hospital and in the clinic. The procedure begins as follows:

1. The patient’s back is washed with antiseptic soap, disinfected with an alcohol solution or iodine preparation, and then covered with a special cloth.
2. The person is laid on the couch - it must be located horizontally on the right or left side.
3. The examinee needs to press his head to his chest, and bend his legs at the knees and pull it close to his stomach. More from him is not required to participate.
4. When puncturing the spine, it is important for the child to explain to the small patient that during the procedure you need to remain calm and try not to move.
5. Next, the doctor determines the puncture site. It is done either between the third and fourth, or between the fourth and fifth spinous vertebral processes. The reference point of the required interspinous gap will be the curve outlining the apex of the ilium of the spine.
6. The selected puncture site is additionally treated with an effective antiseptic.
7. Further, for local anesthesia, the doctor gives the patient an injection of novocaine.

The preparatory part is completed - then the main procedure.

Lumbar puncture

Let's look at how to do a puncture of the spine:

1. 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 somewhat upward.
2. On the way to the subshell space, resistance from contact with the yellow and interspinous folds may be observed. Relatively easily, the instrument passes epidural fatty tissue. The next resistance comes from the meninges.
3. The needle advances gradually - by 1-2 mm.
4. Next, the doctor removes the mandrin from her. After it, the cerebrospinal fluid should flow out. Normally, it is transparent, comes in meager drops.
5. With modern manometers, the doctor measures the pressure in the cerebrospinal fluid.
6. It is strictly forbidden to draw out the fluid with a syringe! This can lead to infringement of the brain stem and its dislocation.

Completion of the procedure

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

Recommendations to the patient after a puncture

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

• Observe bed rest for 18 hours after the event.
• On the day of the procedure, refuse active and intense activity.
• To normal life (without a sparing regime) should be returned only after the permission of the treating doctor.
• Taking painkillers. They reduce the severity of discomfort at the puncture site, fight headaches.

Patient feeling

The whole procedure takes about 45 minutes. To spend all this time in the fetal position, in an almost immobile position, is considered uncomfortable for many subjects.

Reviews of spinal puncture 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 study that is carried out directly during the intake of cerebrospinal fluid.

The evaluation of the indicators is as follows:

• Normal sitting pressure is 300 mm Hg.
• The normal pressure in the supine position is 100-200 mm water column.

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

An increase in this indicator indicates the following:

• Hydrocephalus.
• Water stagnation.
• Various tumor formations.
• Inflammation of the central nervous system.

Laboratory research

Next, the liquor is collected by the doctor in two test tubes of 5 ml. The liquid is sent to the laboratory for the necessary research - bacterioscopic, physico-chemical, bacteriological, PCF-diagnostic, immunological, etc.

Among other things, when conducting an analysis of biomaterial, the laboratory assistant must identify the following:

• Protein concentration in the cerebrospinal fluid sample.
• Concentration in the mass of white blood cells.
• The presence and absence of certain microorganisms.
• The presence of abnormal, deformed, cancer cells in the sample.
• Other indicators characteristic of cerebrospinal fluid.

Normal indicators and deviations from them

Of course, it is impossible for a layman to correctly analyze a sample of cerebrospinal fluid. Therefore, we will provide general introductory information about his research:

• Color. Normally, the liquid is transparent and colorless. Pinkish, yellowish tint, dullness indicate the development of infection.
• Protein is general and specific. Elevated values ​​(more than 45 mg / dl) indicate poor health of the patient, infections, destructive and inflammatory processes.
• White blood cells. Norm - no more than 5 mononuclear white blood cells. If there are more of them in the analysis results, then this fact can also indicate the development of infection.
• Glucose concentration. Low sugar values ​​in the bio-sample also indicate pathological processes.
• The identification of certain bacteria, fungi, viruses, and other organisms in the cerebrospinal fluid indicates a corresponding infection.
• Immature, deformed, cancer cells in the sample indicate the development of cancer.

Complications after the procedure

The consequences of a spinal puncture can be as follows:

• Infection. Gets when medical personnel violate antiseptic discipline. It can manifest itself as an inflammation of the meninges, the development of abscesses. In this case, emergency antibacterial therapy is necessary to prevent death.
• Dislocation complication. A consequence of the drop in cerebrospinal fluid pressure is possible with volume 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 during careless procedure. Hematomas, bleeding may occur. Requires urgent medical attention.
• Traumatic complication. Incorrect puncture can lead to damage to the intervertebral discs, nerve spinal roots. For the patient, this is reflected in back pain.
• Headache. Since intracranial pressure drops when a cerebrospinal fluid sample is taken, this reflects on the patient with a aching, compressive headache. Symptom on its own passes after rest, sleep. However, if the headache does not subside within a week - this is an occasion for an urgent appeal to the doctor.

Now you know how to perform lumbar puncture. We also examined contraindications, indications for it, complications that the procedure threatens.