What is a spinal puncture, is it painful, and possible complications. Features of preparation for a lumbar puncture of the spinal cord: why is a cerebrospinal fluid analysis done? What is a cerebral puncture done for?

For diseases or damage to organs and nerves of the central and peripheral nervous systems, specific examinations may be required. These include puncture spinal cord. In what cases is this procedure performed, why is it done, and is it dangerous?

What is a spinal tap?

Spinal cord puncture or, as it is also called, spinal puncture is a fence cerebrospinal fluid(cerebrospinal fluid) from under the arachnoid membrane of the spinal cord, that is, from the subarachnoid space for diagnostic, anesthetic or therapeutic purposes.

Some people confuse a puncture with a biopsy, in which a piece of tissue from the organ being examined is removed. Because of this, there is an unjustified, exaggerated fear of this kind of analysis. Nothing like this happens during a puncture: only the cerebrospinal fluid that washes both the brain and the spinal cord is examined.

Why is a spinal cord puncture performed?

Diagnostics

For diagnostic purposes, a puncture is taken if the following pathologies are suspected:

• Hemorrhage into the subarachnoid space, which may be caused by:
  • traumatic brain injuries;
  • stroke due to rupture of a cerebral aneurysm;
  • ischemic stroke of the brain or spinal cord.
• Infectious bacterial and viral pathologies CNS:
  • meningitis;
  • encephalitis;
  • arachnoiditis.
• Multiple sclerosis and other diseases associated with the destruction of myelin nerve sheaths.
• Polyneuropathy (eg, lesions peripheral nerves with Guienne-Barre syndrome).
• Spinal injuries.
• Epidural abscess.
• Spinal cord tumors, etc.

Not all of the listed cases require a puncture, but only in those where other examinations do not help. If, for example, adhesions, epidural abscess, ligament damage can be detected using modern accurate hardware examinations using CT or MRI, then why also take a puncture?

Diagnostic sampling of cerebrospinal fluid should be performed only if the symptoms of the disease suggest damage or development pathological process directly in the brain, spinal cord or spinal canal.

Anesthesia

• Epidural anesthesia is performed mainly for pain relief before many operations on joints and bones and in. Its advantages are undoubted:
  • there is no complete loss of consciousness;
  • it is not so harmful to cardiorespiratory activity;
  • the patient comes to his senses faster, he is not as bad as after general anesthesia.
• Epidural anesthesia is also used for very severe neurogenic and fatal pain.
• Even an epidural is possible.

Therapy

It is recommended to administer therapeutic drugs via spinal puncture:

• For diseases of the spinal cord and brain, since the presence of the brain barrier makes it useless intravenous administration medicines. Treatment of encephalitis, meningitis, brain or spinal cord abscess is carried out by injecting the drug into the epidural space.
• For severe injuries or illnesses that require as much as possible fast action drug.

Who is contraindicated for puncture?

Puncture is strictly unacceptable for all kinds of brain dislocations (displacements, wedging of one part of the brain into another, compression of the cerebral hemispheres, etc.). Especially fraught fatal puncture for displacements of the midbrain or its temporal lobe.

• It is also dangerous to perform a puncture if blood clotting is impaired. Two to three weeks before the puncture, you must stop taking anticoagulants and various blood thinning medications (aspirin, NSAIDs, warfarin, etc.).
• The presence of purulent abscesses, wounds and bedsores, a pustular rash on the lower back is also a reason to cancel the puncture.

How to take a puncture

To avoid damaging the spinal cord, the puncture is taken between the second and third lumbar vertebrae in adults, and between the third and fourth in children. This is explained by the fact that the spinal cord in adults usually extends to the level of the second vertebra, and in children it may extend lower - to the third.

For this reason, spinal cord puncture is also called lumbar puncture.

To carry out the puncture, special long Beer needles of reinforced design (thick-walled) with a mandrin (stiletto) are used.

Preparation for puncture

Before collecting cerebrospinal fluid for analysis, it is necessary to conduct an examination:

• pass general and biochemical tests blood and urine;
• do a blood coagulogram;
• change fundus pressure and intracranial pressure;
• at neurological disorders, cerebral signs indicating dislocations - CT or MRI of the brain;
• other tests prescribed by your doctor.

How is a spinal cord puncture performed?

• The patient lies on his side on a hard couch, bending his knees to his stomach and bending his back as much as possible. A sitting position is also allowed.
• The surface of the lower back is treated with iodine solution.
• The needle is inserted into the intervertebral space between the second and third (third and fourth in children) vertebrae, at the level of the spinous processes, slightly at an upward angle.
• At the beginning of the needle's advancement, an obstacle is soon felt (these are vertebral ligaments), but when 4 to 7 cm have been passed (about 2 cm in children), the needle falls under arachnoid membrane and then moves freely.
• At this level, the progress stops, the mandrin is removed, and by the flow of drops of colorless liquid from it, it is confirmed that the goal has been achieved.
• If the liquid does not drip, and the needle rests on something hard, it is carefully returned back without completely removing it from the subcutaneous layer, and the injection is repeated, slightly changing the angle.
• Cerebrospinal fluid is collected in a test tube; the volume of the sample is 120 g.
• If you need to look at the epidural space to see adhesions and tumors, or a condition spinal ligaments, a three-channel procedure is performed (saline solution is supplied through one channel, a needle with a catheter is supplied through the second, and a micro-camera for viewing is supplied through the third).
• Anesthesia or therapy is carried out by injecting an anesthetic or medicinal drug through a catheter.

After the puncture, the patient turns over on his stomach and remains in this position for at least three hours. You absolutely cannot get up right away! This is necessary to prevent the development of complications.

Does it hurt when taking a puncture?

Many patients are afraid that it will hurt. You can calm them down: before the analysis itself, local anesthesia is usually performed: layer-by-layer injection of novocaine (1 - 2%) into the area of ​​the future puncture. And even if the doctor decides that local anesthesia is not needed, in general the puncture is no more painful than a regular injection.

Complications and consequences of spinal cord puncture

After the puncture, the following complications are possible:

• On the membranes of the spinal cord when inserting a hypodermic needle epithelial cells possible development epithelial tumor- cholesteatomas.
• Due to a decrease in the volume of cerebrospinal fluid (daily circulation volume - 0.5 l), intracranial pressure decreases, and a headache may occur for a week.
• If nerves or blood vessels are damaged during a puncture, the consequences can be very unpleasant: pain, loss of sensitivity; formation of hematoma, epidural abscess.

However, such phenomena are extremely rare, since spinal puncture is usually performed by experienced neurosurgeons with experience in numerous operations.

Puncture of cerebrospinal fluid was described by Quincke about 100 years ago. Analysis of cerebrospinal fluid, which is obtained from research results, allows you to correctly identify diseases, establish accurate diagnosis and prescribe effective treatment.

This method provides indispensable information in the diagnosis of disorders nervous system, the presence of infections and many systemic diseases.

A lumbar puncture is a procedure in which cerebrospinal fluid is removed using a special needle.

The liquid (CSF) is used to test for glucose, certain cells, proteins and other components.

It is often examined to identify possible infections.

A spinal tap is part of most diagnostic tests for spinal diseases.

Indications

For meningitis

Meningitis is inflammatory processes in the head (often dorsal) meninges. According to the nature of the etiology, meningitis can have a viral, fungal, or bacterial form.

Meningeal syndrome is often preceded by infectious diseases, and in order to accurately establish the nature and causes of meningitis, the patient is prescribed a lumbar puncture.

During this procedure, the cerebrospinal fluid of the brain is examined.

Based on the results of the examination, intracranial pressure, the volume of neutrophil cells, and the presence of bacteria (Haemophilus influenzae, meningococcus, pneumococcus) are determined.

Lumbar puncture is indicated at the slightest suspicion of purulent meningitis.

For stroke

Stroke is an acute disorder of the blood circulation in the brain.

A lumbar puncture is prescribed to differentiate a stroke and identify the nature of its occurrence.

To do this, the cerebrospinal fluid is placed in 3 different tubes and the blood impurity in each of the tubes is compared.

For multiple sclerosis

Multiple sclerosis is a disease of the nervous system that affects the brain as well as the spinal cord. The main cause of the disease is considered to be dysfunction of the immune system.

The disease occurs when the myelin substance that covers the nerve fibers is destroyed and sclerosis (a type of connective tissue) forms.

Figure: multiple sclerosis

Multiple sclerosis is difficult to diagnose. Therefore, in order to conduct an accurate study, the patient is prescribed a study using lumbar puncture.

During this procedure, the cerebrospinal fluid is examined for the presence of antibodies (increased immunoglobulin index).

If the test result is positive, doctors talk about the presence of an abnormal immune response, that is, multiple sclerosis.

For tuberculosis

If tuberculosis is suspected, it is mandatory.

It is carried out to study the cerebrospinal fluid and determine the volume of sugar, neutrophils, and lymphocytes in it.

If the amount of these substances in the cerebrospinal fluid changes, the patient is diagnosed with tuberculosis and the degree of the disease is established.

For syphilis

Indicated for congenital and tertiary forms of syphilis, in case of suspected syphilitic damage to the nervous system (central).

The purpose of the procedure is to identify the symptoms of the disease, as well as the disease itself (syphilis) in its asymptomatic manifestations.

For hydrocephalus

Hydrocephalus is an excess of cerebrospinal fluid in the ventricular system of the brain or in the subarachnoid region.

The increased pressure created by the cerebrospinal fluid on the brain tissue can provoke disorders of the central nervous system.

Based on the results of a lumbar puncture, the pressure of cerebrospinal fluid in the brain tissue is diagnosed.

When it is removed in a volume of 50-60 ml, the condition of patients in 90% of cases improves for some time.

For subarachnoid hemorrhage

A subarachnoid hemorrhage is sudden bleeding into the subarachnoid area.

Fig.: cerebral hemorrhage

It is accompanied by sudden headaches and periodic disturbances of consciousness.

Lumbar puncture is considered the most reliable, accurate and accessible method for diagnosing subarachnoid hemorrhage. Its purpose is to examine the cerebrospinal fluid for the intensity of blood saturation.

At positive results test, the patient is diagnosed with subarachnoid hemorrhage.

For the flu

Prescribed for influenza in order to establish factors and symptoms colds and identifying possible infections.

Mild meningeal syndromes often occur against the background of influenza, so in this case Lumbar puncture is considered the most effective diagnostic test.

For other diseases

Lumbar puncture is prescribed:

• if you suspect different shapes neuroinfections;
• in the presence of oncological disorders in the brain;
• for the purpose of diagnosing hemoblastoses for the appearance of blood blast cells, increasing protein levels;
• For diagnostic study normal pressure hydrocephalus;
• for the purpose of studying liquorodynamic disorders.

During pregnancy

This procedure is considered dangerous for expectant mother and for the fetus:

• it can cause premature birth or miscarriage:
• Upon completion of the puncture, a pregnant woman may develop reactions leading to disturbances in the functioning of the heart, and in some cases, to brain hypoxia.

In newborns and children

Children are prescribed for:

• suspected meningitis to determine what infection (viral, bacterial) caused the disease;
• the need to determine the volume of protein and red blood cells - insufficient levels can cause infectious diseases of varying complexity.

Fig.: location of lumbar puncture in children

Contraindications for the procedure

Lumbar puncture is contraindicated if:

• intracranial hematoma;
• post-traumatic brain abscess;
• infringement of the brain stem;
• traumatic shock;
• heavy blood loss;
• cerebral edema;
• intracranial hypertension;
• volumetric formation of the brain;
• existing infectious (purulent) processes in the lumbar region;
• the presence of extensive damage to soft spinal tissues;
• bedsores of the lumbosacral area;
• axial dislocation of the brain;
• occlusive form of hydrocephalus
• diathesis of hemorrhagic form;
• pathologies of the spinal (cerebral) canals, accompanied by impaired cerebrospinal fluid circulation;
• subcutaneous infections and their presence in the epidural space;
• brain injuries.

Possible complications (consequences)

Complications based on the results of lumbar puncture appear when the procedure is performed incorrectly.

Violations diagnostic equipment can cause many undesirable consequences:

• Postpuncture syndrome. This pathology occurs when epithelial cells are transferred to the membranes of the spinal cord, which leads to dilation and displacement of intracranial vessels.
• Hemorrhagic complications. These include intracranial hematoma (chronic or acute form), intracerebral hematoma, its spinal subarachnoid form. Improper procedure can damage blood vessels and cause bleeding.
• Teratogenic factor. This includes epidermoid tumors that form in the spinal canals, which can appear as a result of displacement of skin elements into the area of ​​the spinal canal. Tumors are accompanied aching pain in the lower legs, lumbar region; painful attacks can progress over the years. The reason is an incorrectly inserted stylet or its absence in the needle itself.
• Direct injury. Improper implementation of the procedure can cause various damage to the patient’s roots (nerves), infectious complications, various forms of meningitis, damage to intervertebral discs.
• Liquorodynamic complications. If a tumor of the spinal canal develops, then changes in cerebrospinal fluid pressure during the procedure can provoke acute pain or an increase in neurological deficit.
• Changes in liquor composition. If the subarachnoid area is injected foreign bodies(air, various anesthetics, chemotherapy drugs and other substances), they can provoke a weak or increased meningeal reaction.
• Other complications. Minor and quickly disappearing complications include nausea, vomiting, and dizziness. Improper lumbar puncture causes myelitis, radiculitis, and arachnoid.

Algorithm

Lumbar puncture is performed qualified doctor with the presence of a nurse.

Nurse:

• prepares a kit for a spinal puncture (it consists of sterile cotton wool, a 3 percent iodine solution, a 0.5 percent novocaine solution, a special needle, alcohol, sterile gloves, test tubes);
• prepares the patient for the procedure;
• assists the doctor in the process of performing manipulations;
• Provides necessary care to the patient after the procedure.

Photo: needles for puncture of cerebrospinal fluid

To properly perform a lumbar puncture, you must:

• place the patient in a certain sitting position;
• determine the puncture site and treat the nearby area with an alcohol solution;
• administer skin anesthesia;
• perform a spinal tap;
• remove the mandrin and place it in a sterile test tube;
• collect a specified amount of cerebrospinal fluid for research;
• it is necessary to insert a mandrin into the needle, and then carefully remove the needle;
• treat the puncture site;
• apply a bandage.

Patient preparation

Before performing a lumbar puncture, the patient must notify the attending physician:

• about the use of any medications;
• presence of allergic reactions;
• presence (absence) of pregnancy;
• O possible violations in blood clotting.

The patient is prepared in compliance with certain conditions:

• Before the patient begins the procedure bladder must be completely emptied.
• When lumbar puncture is part x-ray examination, the patient needs to cleanse the intestines to eliminate the accumulation of gases (intestinal contents) when imaging the spine.
• The patient is transported to the ward room on a gurney in a horizontal position (on his stomach).
• In the room, the patient is placed in a sitting position and bent forward or placed in a “side-lying” position, in which the knees are bent towards the stomach. Next, skin anesthesia is performed and the operation itself is carried out.

Technique

Typically, a spinal tap is performed in inpatient conditions in the following way:

• The puncture area is determined. It is located between the 3-4 or 4-5 lumbar vertebrae.
• The nearby area is being processed 3 times percent iodine and 70 percent ethyl alcohol(from the center to the periphery).
• An anesthetic solution is injected (5-6 ml is enough). Novocaine is most often used as anesthesia.
• Between the spinous processes, adhering to the midline, a “Bira” needle is inserted with a slight slope.
• The needle should enter the subarachnoid area (the needle can be felt at a depth of 5-6 cm).
• When the mander is removed, the cerebrospinal fluid should flow out. This confirms that the procedure was carried out correctly. For an accurate analysis, it is necessary to collect about 120 ml of cerebrospinal fluid.
• After collecting the cerebrospinal fluid, it is necessary to measure the patient's pressure.
• The injection site is treated with an antiseptic solution.
• A sterile dressing is applied.

The duration of the procedure is about half an hour.

What sensations does the patient experience during a lumbar puncture?

If the procedure is performed correctly, the patient should not feel discomfort, discomfort and pain.

Sometimes the patient may feel:

• patency of the needle, which is not accompanied by painful symptoms;
• a small injection when injecting an anesthetic solution;
• the effect of a slight electric shock if a spinal puncture needle touches a portion of the spinal nerve.
• pain in the head (about 15% of patients feel them during a lumbar puncture).

Caring for the patient after the procedure

Upon completion of the spinal tap, patients:

• bed rest is prescribed for a day (sometimes bed rest is prescribed for up to 3 days - if certain medications are administered to the subarachnoid area).
• you need to take a horizontal position and lie on your stomach;
• it is necessary to create conditions of rest, provide plenty of drink (not cold);
• administer intravenous plasma expanders (if necessary).

Sometimes after the procedure the patient experiences:

• fever, chills, or tightness in the neck area;
• numbness and discharge from the puncture site.

In such cases, urgent consultation with a doctor is required.

results

The purpose of a lumbar puncture is to obtain cerebrospinal fluid and its subsequent examination.

Based on the results of a spinal puncture, cerebrospinal fluid is examined, which can be presented in one of four options:

• Blood: indicates the presence of hemorrhagic processes ( initial stage subarachnoid hemorrhage).
• Yellowish color: due to the long-standing processes of a hemorrhagic nature (chronic hematomas, meningeal carcinomatosis, blockage of liquor circulation in the subarachnoid region).
• Grayish green color: often indicates the presence of brain tumors;
• Clear liquor- this is the norm.

Norm and pathology

The cerebrospinal fluid undergoes a complete examination:

• CSF pressure is measured;
• the liquid is assessed macroscopically;
• the volume of protein and sugar is determined;
• cell morphologies are examined.

Norm:

• Cerebrospinal fluid color: clear
• Protein content: 150 – 450 mg/l
• Glucose volume: from 60% in blood
• Atypical cells: no
• Leukocytes: up to 5 mm3
• Neutrophils: no
• Red blood cells: no
• The normal liquor pressure is 150-200 water. Art. or 1.5 – 1.9 kPa.

Deviation from the norm may indicate the presence of liquor hypertension.

If the pressure exceeds the norm (more than 1.9 kPa), this is an indication for decongestant therapy. If the cerebrospinal fluid pressure is low (less than 1.5 kPa), this indicates the presence of brain pathologies (severe swelling, blockage of the cerebrospinal fluid pathways in the spinal canals).

Besides:

• With various pathologies, red blood cells, neutrophils and pus are detected in the blood.
• The presence of atypical cells may indicate a brain tumor.
• A low glucose value is an indicator of bacterial meningitis.

Photo: malignant cells in the cerebrospinal fluid

What can affect the result?

Unfortunately, the result of a lumbar puncture can be affected by:

• restless position of the patient during the procedure;
• obesity;
• dehydration;
• severe arthritis;
• previous spinal surgeries;
• bleeding into the cerebrospinal fluid;
• With proper puncture, it is impossible to collect cerebrospinal fluid.

Lumbar puncture can be invaluable in diagnosing diseases and infections that are dangerous to the body.

When performed correctly, the procedure is absolutely safe.

Video: goals and features of the event

A puncture of cerebrospinal fluid in medical terminology is designated as a lumbar puncture, and the fluid itself is called cerebrospinal fluid. Lumbar puncture is one of the most complex methods that has diagnostic, anesthetic and medicinal purposes. The procedure involves inserting a special sterile needle (length up to 6 cm) between the 3rd and 4th vertebrae under the arachnoid membrane of the spinal cord, and the brain itself is not affected at all, and then extracting a certain dose of cerebrospinal fluid. It is this liquid that allows you to obtain accurate and useful information. In laboratory conditions, it is examined for the content of cells and various microorganisms to identify proteins, various types of infections, and glucose. The doctor also evaluates the transparency of the cerebrospinal fluid.

Indications for spinal cord puncture

A spinal tap is most often used when central nervous system infections such as meningitis and encephalitis are suspected. Multiple sclerosis is very difficult to diagnose, so a lumbar puncture is indispensable. As a result of the puncture, the cerebrospinal fluid is examined for the presence of antibodies. If antibodies are present in the body, the diagnosis of multiple sclerosis is almost established. The puncture is used to differentiate a stroke and identify the nature of its occurrence. The cerebrospinal fluid is collected into 3 test tubes, and later the blood mixture is compared.

With the use of lumbar puncture, diagnosis helps to detect inflammation of the brain, subarachnoid bleeding or detect herniated intervertebral discs by injecting a contrast agent, as well as measure the pressure of the spinal cord fluid. In addition to collecting liquid for research, specialists also pay attention to the flow rate, i.e. if one clear drop appears in one second, the patient has no problems in that area. IN medical practice spinal puncture, consequences which can sometimes be very serious, is prescribed in order to remove excess cerebrospinal fluid and thereby reduce intracranial pressure in benign hypertension, is carried out to administer medications for various diseases, for example, chronic normotensive hydrocephalus.

Contraindications to lumbar puncture

The use of lumbar puncture is contraindicated for injuries, diseases, formations and certain processes in the body:

edema, space-occupying formations of the brain;

Intracranial hematoma;

Dropsy with a mass formation in the temporal or frontal lobe;

Brain stem entrapment;

Bedsores of the lumbosacral area;

Heavy bleeding;

Skin and subcutaneous infections in the lumbar region;

Thrombocytopenia;

The patient's condition is extremely serious.

In any case, the doctor first performs a series of tests to make sure urgent need appointments spinal puncture. Consequences it, as already noted, can be very, very serious, since the procedure is risky, and it is associated with certain risks.

Spinal cord puncture and its consequences

The first few hours (2-3 hours) after the procedure should not get up under any circumstances, you must lie on a flat surface on your stomach (without a pillow), later you can lie on your side, for 3-5 days you should observe strict bed rest and do not take standing or sitting position to avoid various complications. Some patients after a lumbar puncture experience weakness, nausea, pain in the spine and headache. The doctor may prescribe medications (anti-inflammatory and painkillers) to relieve or reduce symptoms. Complications after lumbar puncture may occur due to incorrect procedure. Here is a list of possible complications as a result of incorrect actions:

injury varying degrees spinal nerve complications;

Various brain pathologies;

Formation of epidermoid tumors in the spinal canal;

Damage to intervertebral discs;

Increased intracranial pressure in oncology;

Infection.

If the procedure was performed by a qualified specialist, all necessary rules were strictly followed, and the patient follows the doctor’s recommendations, then its consequences are minimized. Contact our medical Center where only experienced doctors work, do not risk your health!

Spinal cord puncture (lumbar puncture) is a type of diagnosis that is quite complex. The procedure removes a small amount of cerebrospinal fluid or injects drugs and other substances into the lumbar spinal canal. In this process, the spinal cord is not directly affected. The risk that arises during puncture contributes to the rare use of the method exclusively in a hospital setting.

Purpose of a spinal tap

Spinal cord puncture is performed for:

Performing a spinal tap

• collecting a small amount of cerebrospinal fluid (CSF). Subsequently, their histology is carried out;
• measuring the pressure of cerebrospinal fluid in the spinal canal;
• removal of excess cerebrospinal fluid;
• administration of drugs into the spinal canal;
• relief of difficult labor in order to prevent painful shock, as well as as anesthesia before surgery;
• determining the nature of the stroke;
• isolation of tumor markers;
• performing cisternography and myelography.

Using a spinal tap, the following diseases are diagnosed:

• bacterial, fungal and viral infections(meningitis, encephalitis, syphilis, arachnoiditis);
• subarachnoid bleeding (bleeding in the brain);
• malignant tumors of the brain and spinal cord;
• inflammatory conditions of the nervous system (Guillain-Barré syndrome, multiple sclerosis);
• autoimmune and dystrophic processes.

Often a spinal tap is equated with a bone marrow biopsy, but this statement is not entirely correct. During a biopsy, a tissue sample is taken for further research. Access to the bone marrow is achieved through a puncture of the sternum. This method allows you to identify bone marrow pathologies, some blood diseases (anemia, leukocytosis and others), as well as metastases in bone marrow. In some cases, a biopsy can be performed during the puncture process.

To prevent and treat JOINT DISEASES, our regular reader uses the increasingly popular NON-SURGERY treatment method recommended by leading German and Israeli orthopedists. After carefully reviewing it, we decided to offer it to your attention.

Indications for spinal cord puncture

IN mandatory spinal cord puncture is performed when infectious diseases, hemorrhages, malignant neoplasms.

Inflammatory polyneuropathy

A puncture is taken in some cases for relative indications:

• inflammatory polyneuropathy;
• fever of unknown pathogenesis;
• demyelinating diseases (multiple sclerosis);
• systemic connective tissue diseases.

Preparatory stage

Before the procedure, medical workers explain to the patient: why the puncture is being performed, how to behave during the manipulation, how to prepare for it, and possible risks and complications.

Spinal cord puncture requires the following preparation:

1. Registration of written consent for the manipulation.
2. Taking blood tests to evaluate blood clotting, as well as the functioning of the kidneys and liver.
3. Hydrocephalus and some other diseases require computed tomography and MRI of the brain.
4. Collection of information on the medical history, recent and chronic pathological processes.

The specialist must be informed about the medications taken by the patient. medicines, especially those that thin the blood (Warfarin, Heparin), relieve pain, or have an anti-inflammatory effect (Aspirin, Ibuprofen). The doctor must be aware of the existing allergic reaction, called local anesthetics, drugs for anesthesia, iodine-containing agents (Novocaine, Lidocaine, iodine, alcohol), as well as contrast agents.

It is necessary to stop taking blood thinning drugs, as well as analgesics and non-steroidal anti-inflammatory drugs in advance.

Before the procedure, water and food are not consumed for 12 hours.

Women must provide information about their suspected pregnancy. This information is necessary due to the expected x-ray examination during the procedure and the use of anesthetics, which may have undesirable effect for the unborn child.

The doctor may prescribe medicinal product, which must be taken before the procedure.

The presence of a person who will be next to the patient is mandatory. A child is allowed to undergo a spinal puncture in the presence of his mother or father.

Technique of the procedure

A spinal cord puncture is performed in a hospital ward or treatment room. Before the procedure, the patient empties his bladder and changes into hospital clothes.

Spinal cord puncture

The patient lies on his side, bends his legs and presses them to his stomach. The neck should also be in a bent position, with the chin pressed to the chest. In some cases, spinal puncture is performed with the patient sitting. The back should be as motionless as possible.

The skin in the puncture area is cleaned of hair, disinfected and covered with a sterile napkin.

The specialist can use general anesthesia or use the drug local anesthesia. In some cases, a drug with a sedative effect may be used. Also during the procedure, heartbeat, pulse and blood pressure are monitored.

The histological structure of the spinal cord provides for the safest needle insertion between the 3rd and 4th or 4th and 5th lumbar vertebrae. Fluoroscopy allows you to display a video image on a monitor and monitor the manipulation process.

Next, the specialist takes cerebrospinal fluid for further research, removes excess cerebrospinal fluid or injects necessary drug. The liquid is released without outside help and fills the test tube drop by drop. Next, the needle is removed skin covered with a bandage.

CSF samples are sent to laboratory test, where the histology itself takes place.

Spinal cord cerebrospinal fluid

The doctor begins to draw conclusions on the nature of the fluid exit and its appearance. In its normal state, the cerebrospinal fluid is transparent and flows out one drop per second.

At the end of the procedure you must:

• adherence to bed rest for 3 to 5 days as recommended by a doctor;
• keeping the body in a horizontal position for at least three hours;
• getting rid of physical activity.

When the puncture site is very painful, you can resort to painkillers.

Risks

Adverse consequences after spinal cord puncture occur in 1–5 cases out of 1000. There is a risk of:

Intervertebral hernia

• axial wedging;
• meningism (symptoms of meningitis occur in the absence of an inflammatory process);
• infectious diseases of the central nervous system;
• severe headache, nausea, vomiting, dizziness. Your head may hurt for several days;
• damage to the spinal cord roots;
• bleeding;
• intervertebral hernia;
• epidermoid cyst;
• meningeal reaction.

If the consequences of the puncture are expressed in chills, numbness, fever, a feeling of tightness in the neck, or discharge at the puncture site, you should immediately consult a doctor.

There is an opinion that during a spinal tap the spinal cord can be damaged. It is erroneous, since the spinal cord is located higher than the lumbar spine, where the puncture is directly made.

Contraindications to spinal cord puncture

Spinal cord puncture, like many research methods, has contraindications. Puncture is prohibited in case of sharply increased intracranial pressure, dropsy or cerebral edema, the presence of various formations in the brain.

It is not recommended to take a puncture if there are pustular rashes in the lumbar region, pregnancy, impaired blood clotting, taking blood thinning drugs, or ruptured aneurysms of the brain or spinal cord.

In each individual case, the doctor must analyze in detail the risk of the manipulation and its consequences for the life and health of the patient.

It is advisable to contact an experienced doctor, who will not only explain in detail why it is necessary to perform a spinal cord puncture, but will also carry out the procedure with minimal risk to the patient’s health.

I. Indications for lumbar puncture

Suspicion of meningitis, meningoencephalitis.

Convulsive syndrome of unknown origin.

Coma of unknown etiology.

Fever (38 – 40 0) of unknown origin in young children.

Presence of acute flaccid paralysis or paresis.

Contraindications for lumbar puncture

Picture of infectious-toxic shock.

Brain swelling.

Dislocation and herniation of the brain.

The presence of bright focal symptoms (puncture is done after an examination of the fundus, CT, MRI if a space-occupying process such as a tumor, hematoma, abscess is excluded).

II. Technique for performing a spinal (lumbar) puncture

Prepare for puncture a sterile needle with a mandrel, two test tubes, one of them must be sterile and have a stopper.

The patient is placed on the manipulation table on his right side.

The doctor performing the puncture washes his hands thoroughly, puts on sterile gloves, and treats them with alcohol.

Before performing a puncture, the nurse treats the skin over the lumbar spine, starting from the site of the intended puncture and further, in diverging circles, first 2 times with iodine, and then 3 times with alcohol to completely remove any remaining iodine. In addition, the skin above the ridge is processed ilium.

The assistant fixing the patient bends him as much as possible to increase the space between the spinous processes of the vertebrae.

The doctor determines the site of insertion of the puncture needle. He feels the iliac crest and lowers a perpendicular from it to the spine, the intersection point corresponds to the space between the 3rd and 4th lumbar vertebrae. The puncture can be performed in this gap or up one vertebrae; at these levels there is no brain matter, so the puncture is safe.

Before the puncture, you can anesthetize the puncture site with lidocaine or procaine: 0.1 - 0.2 ml of anesthetic is injected intradermally, forming a “lemon peel”, then 0.2 - 0.5 ml of anesthetic is injected into the deeper layers of the skin. More often, the puncture is performed without prior anesthesia.

A needle with a mandrel cut upward is inserted perpendicular to the skin into the center of the intervertebral space, then the needle is advanced slowly, slightly deflecting the needle tip (by 10 - 15 0) towards the head end. When advancing the needle, the doctor feels three failures: after puncture of the skin, intervertebral ligament and dura mater.

After the third failure, remove the mandrin and see if any cerebrospinal fluid is released from the puncture needle. If there is no fluid, then the needle is advanced until cerebrospinal fluid appears, and the mandrel is periodically (every 2–3 mm) removed. Care must be taken not to push the needle too far and puncture the anterior venous plexus of the spinal canal - this is the most common complication of lumbar puncture.

When the needle has reached the spinal canal, it is necessary to measure the pressure of the cerebrospinal fluid: the mandrel is removed from the needle, a locking device and a pressure gauge are attached to the needle, and the pressure is determined by the height of the cerebrospinal fluid column in the manometer. In the absence of a manometer, cerebrospinal fluid pressure is estimated approximately by the rate of cerebrospinal fluid flow from the needle. U healthy person The liquor flows out in rare drops - 40-60 drops per minute.

After turning off the pressure gauge, cerebrospinal fluid is collected into two test tubes: a) 2 ml is taken into a sterile test tube. for bacterioscopic, bacteriological research and latex agglutination reactions (RLAs); b) into the second test tube - to determine the cellular composition, protein concentration, glucose (1 ml.) It is necessary to prevent the rapid flow of cerebrospinal fluid by regulating the rate of its removal with a mandrel.

After collecting the cerebrospinal fluid, the needle is removed without inserting the mandrel completely, since pinching of the spinal roots and their subsequent tearing off when removing the needle is possible, which will cause the appearance of pain syndrome and movement disorders.

A dry sterile cotton swab is placed on the skin in the area of ​​the puncture hole and secured with a bandage.

After the puncture, the patient is transported in a horizontal position to the bed and placed on his stomach for 2 hours without a pillow under his head. Children in the first year of life are placed on their backs with a pillow under their buttocks and legs. The horizontal position of the patient with the head end slightly lowered allows one to avoid complications of spinal puncture - dislocation of the brain and its wedging into the foramen magnum.

For 3 to 4 hours after puncture (every 15 minutes), observe the patient's condition in order to promptly recognize brain dislocation and provide emergency assistance, because through a puncture hole in the hard meninges After another 4–6 hours, cerebrospinal fluid leaks out.

After a lumbar puncture, the patient must observe strict bed rest: for 2 - 3 days upon receipt normal indicators cerebrospinal fluid, and up to 14 days – if pathological changes in the cerebrospinal fluid are detected.