Spinal puncture

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A spinal puncture, also called a spinal tap, lumbar puncture, or LP is "tapping of the subarachnoid space in the lumbar region, usually between the third and fourth lumbar vertebrae.[1][2][3][4]

Procedure

Use of an 'atraumatic needle' may reduce the chance of headache, although this needle is more difficult to use and may increase the number attempts needed before successful puncture.[2] Reinsertion of the stylet before needle removal decreases headache.[2]

To accurately measure the opening pressure of the cerebrospinal fluid:

  • The patient should be laying (not sitting)[5][6][7][8]
  • The patient's neck should be relaxed to prevent Queckenstedt's test which can raise pressure by 10-20 cm[9]

References

  1. ↑ Anonymous (2024), Spinal puncture (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ 2.0 2.1 2.2 Straus SE, Thorpe KE, Holroyd-Leduc J (October 2006). "How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis?". JAMA 296 (16): 2012–22. DOI:10.1001/jama.296.16.2012. PMID 17062865. Research Blogging.
  3. ↑ Ellenby MS, Tegtmeyer K, Lai S, Braner DA (September 2006). "Videos in clinical medicine. Lumbar puncture". N. Engl. J. Med. 355 (13): e12. DOI:10.1056/NEJMvcm054952. PMID 17005943. Research Blogging.
  4. ↑ Marton KI, Gean AD (1986). "The spinal tap: a new look at an old test.". Ann Intern Med 104 (6): 840-8. PMID 3518565.
  5. ↑ Becht FC (1920) Studies on the cerebrospinal fluid. Am J Physio 1920;51(1):1-125**
  6. ↑ Loman J, Myerson A, Goldman D. Effects of alterations in posture on the cerebrospinal fluid pressure. Arch Neurol Psych. 1934:1279-1295.**
  7. ↑ Magnaes B (1976). "Body position and cerebrospinal fluid pressure. Part 1: clinical studies on the effect of rapid postural changes.". J Neurosurg 44 (6): 687-97. DOI:10.3171/jns.1976.44.6.0687. PMID 1271089. Research Blogging. **
  8. ↑ Magnaes B (1976). "Body position and cerebrospinal fluid pressure. Part 2: clinical studies on orthostatic pressure and the hydrostatic indifferent point.". J Neurosurg 44 (6): 698-705. DOI:10.3171/jns.1976.44.6.0698. PMID 1271090. Research Blogging.
  9. ↑ Deliyannakis E (1971). "Influence of the position of the head on the cerebrospinal fluid pressure. Variations of the Queckenstedt sign.". Mil Med 136 (4): 370-2. PMID 5005427. **
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