Puncture of the spinal cord: why and how of lumbar puncture
A lumbar spinal tap (lumbar puncture, spinal, lumbar or lumbar puncture) is done lower back, in the lumbar level of the spine. During the operation, the medical needle is inserted between two lumbar bones of the spine (vertebrae), or to obtain a sample of spinal fluid or for therapeutic or anesthetic to numb the area or to carry out therapeutic measures.
The procedure allows professionals to detect dangerous pathology:
- various disorders of the Central nervous system;
- demyelinating multiple sclerosis;
- all sorts of varieties of cancer of the brain and spinal cord.
Sometimes doctors use lumbar puncture for administration of anesthetics during chemotherapy.
Why do puncture
Lumbar puncture of the spinal cord are recommended by doctors for:
- selection of the cerebrospinal fluid for research;
- determine the magnitude of the pressure in the cerebrospinal fluid;
- a spinal anesthetic;
- of chemotherapeutic drugs and medicinal solutions;
- perform myelography and cisternography.
Puncture of the spinal cord for the listed procedures to the patient by means of injection introduces a pigment solution or a radioactive composition, in order to clearly show the jet fluid.
The information collected by this procedure can detect:
- threat of microbial, viral and fungal infections, including encephalitis, syphilis and meningitis;
- hemorrhage in the subarachnoid space of the brain (NAO);
- some types of cancer arising in the brain and spinal cord;
- a large part of inflammatory conditions of the CNS, e.g. multiple sclerosis, acute polyradiculitis, various paralyses.
Risks and consequences of lumbar puncture
Lumbar puncture of the spine — a dangerous procedure. Getting a puncture can only be a qualified doctor with special tools and deep knowledge.
Manipulation in the area of the spine can have negative consequences. They can lead to:
- increase in intracranial pressure;
- the herniation;
- the development of cholesteatoma — a tumor-like formations containing necrotic epithelial cells and a mixture of other substances.
Quite often, the patients after performing lumbar puncture experience severe headache. Malaise is caused due to the leakage of liquid in close tissue.
Headache patients often notice sitting and standing. It often takes place when the patient goes to bed. Given the existing situation, the doctors recommended for the first 2-3 days after surgery to lead a sedentary life and to stay in bed.
Unceasing pain in the spine is a common ailment experienced by patients undergoing a spinal tap. The pain may be localized at the site of puncture and to extend downward along the rear surface of the legs.
The main contraindications
Lumbar puncture spinal is absolutely contraindicated in patients who are suspected or already identified dislocation of the brain, discovered the presence of stem symptoms.
The drop in liquor pressure in the spinal volume (in the presence of a nidus of high blood pressure) can have dangerous consequences. It can run gears of infringement of the brain stem and thus cause death of the patient in the operating room.
Special precautions should be used when performing the puncture to patients with bleeding disorders, people who are prone to bleeding and taking blood thinners (anticoagulants). These include:
- some commercial analgesics such as aspirin, Ivolgin or naproxen sodium.
How to produce a puncture
Lumbar puncture can be performed in a clinic or hospital. Before the procedure, the patient’s back is washed with antiseptic soap, disinfected with alcohol or iodine and covered with sterile cloth. The puncture site is disinfected with an effective anesthetic.
Such a puncture is done between the third and fourth or fourth and fifth spinous process of the spine. Guide interspinal gap is the curve that delineates the top of the iliac bones of the spine.
A patient who will be subjected to the procedure, laid horizontally on the couch (on the left or right side). His bent legs pressed against the abdomen, and the head to the chest. The skin in the area of puncture is treated with iodine and alcohol. The puncture site obespechivaetsya by subcutaneous injection of a solution of novocaine.
During the period of anesthesia, the doctor performs the puncture sub space medical needle with mandrina length of 10-12 cm and a thickness of 0.5-1 mm. Introduce the needle, the doctor should be strictly in the sagittal plane and direct it slightly upward (respectively imbricate spinous location of the lesion).
Needle during the approach sub space will experience resistance from contact interspinal and yellow ligaments, it is easy to overcome the layers of the epidural fat and to find resistance during the passage of strong meninges.
At the moment of puncture to the doctor and the patient creates a feeling of dropping the needle. It is quite a normal phenomenon which should not be feared. The needle should be advanced in the course of 1-2 mm and to remove the stylet. Mandrina after removal from the needle must drain cerebrospinal fluid. The normal fluid must have a transparent color and scarce flow drops. For measuring pressure in the cerebrospinal fluid can be used modern pressure gauges.
Pulling a syringe of liquor is strictly prohibited as it can lead to transtentorial herniation and incarceration of the barrel.
After determining the pressure and sampling of cerebrospinal fluid the needle of the syringe should be removed and the area of the puncture — stick sterile pad. The procedure lasts about 45 minutes. After the puncture the patient must stay in bed for at least 18 hours.
What happens after the procedure
Patients are not allowed to perform active and hard work on the day of the procedure. To return to normal, the patient can only after doctor’s permission.
After puncture the majority of patients, the use of painkillers, which may relieve headache and pain in the area of the puncture.
A sample of the fluid withdrawn by puncture, placed in a box and delivered to the laboratory for analysis. Laboratory as a result of research activities explains:
- indicators of cerebrospinal fluid;
- the protein concentration in the sample;
- the concentration of white blood cells;
- the presence of microorganisms;
- the existence of a mutilated and cancer cells in the sample.
What should be the indicators of the cerebrospinal fluid? A good result is characterized by a clear, colorless liquid. If the sample has a dull yellowish or pinkish hue, it proves the presence of infection.
We study the protein concentration in the sample (presence of total protein and specific proteins). Increased protein content talks about the poor health of the patient, the development of inflammatory processes. If the protein levels above 45 mg/DL, may be present infection and destructive processes.
The important concentration of white blood cells. The example in the rule should contain up to 5 mononuclear leukocytes (white blood cells). The increase in the number of white blood cells indicates the presence of infection.
Attention is drawn to the concentration of sugar (glucose). Low sugar levels in the selected sample confirms the presence of infection or other pathological conditions.
Detection of bacteria, viruses, fungi, or any microorganism indicates the development of infection.
Detection of cancer, deformed or immature blood cells confirms the presence of some forms of cancer.
Laboratory tests allow the physician to establish an accurate diagnosis of the disease.