Is a puncture dangerous? Lumbar (spinal) puncture

Spinal puncture is an important step in the diagnosis of neurological pathologies and infectious diseases, as well as one of the methods of drug administration and anesthesia.

Often this procedure is called a lumbar puncture, lumbar puncture.

Thanks to computed tomography and magnetic resonance therapy, the number of punctures performed has significantly decreased.

However, they cannot completely replace the capabilities of this procedure.

Spinal puncture

About the puncture technique

There is a puncture technique that is not allowed to be violated and is the grossest mistake of the surgeon. According to the correct one, such an event should be referred to as a puncture of the subarachnoid space or, more simply, a spinal puncture.

Liquor is located under the meninges, in the ventricular system. Thus, nerve fibers are fed, brain protection is created.

When a disorder occurs due to a disease, the cerebrospinal fluid can increase, causing increased pressure in the skull. If an infectious process joins, then the cellular composition undergoes changes and, in case of hemorrhages, blood appears.

The lumbar region is pierced not only for medicinal purposes to administer the drug, but also to diagnose or confirm the alleged diagnosis. It is also a popular method of anesthesia for surgical intervention on the organs of the peritoneum and small pelvis.

Be sure to study the indications and contraindications when deciding on spinal cord puncture. It is not allowed to ignore this clear list, otherwise the safety of the patient is violated. Of course, without reasons, such an intervention is not prescribed by a doctor.

Who can appoint a puncture?

The indications for such a manipulation are as follows:

• alleged infection of the brain and its membranes - these are diseases such as syphilis, meningitis, encephalitis and others;
• diagnostic measures in the formation of hemorrhages and the appearance of formations. It is used for information impotence of CT and MRI;
• the task is to determine the cerebrospinal fluid pressure;
• coma and other disorders of consciousness;
• when it is necessary to inject a drug in the form of cytostatics and antibiotics directly under the membranes of the brain;
• x-ray with the introduction of a contrast agent;
• the need to reduce intracranial pressure and remove excess fluid;
• processes in the form of multiple sclerosis, polyneuroradiculoneuritis, systemic lupus erythematosus;
• unreasonable increase in body temperature;
• spinal anesthesia.

Absolute indications - tumors, neuroinfections, hemorrhages, hydrocephalus.

Sclerosis, lupus, incomprehensible fever - do not oblige to be investigated in this way.

The procedure is necessary in case of an infectious lesion, since it is important not only to diagnose the diagnosis, but also to understand what kind of treatment is required, to determine the sensitivity of microbes to antibiotics.

A puncture is also used to remove excess fluid with high intracranial pressure.

If we talk about therapeutic properties, then in this way it is possible to act directly on the focus of neoplastic growth. This will allow to have an active effect on tumor cells without an elephantine dose of drugs.

That is, the cerebrospinal fluid performs many functions - it detects pathogens, is a carrier of information about the cellular composition, blood impurities, detects tumor cells and tells about the pressure of the cerebrospinal fluid.

Important! Be sure to exclude possible pathologies, contraindications and risks before the puncture. Failure to do so can lead to the death of the patient.

When a spinal tap cannot be performed

Sometimes this diagnostic and treatment procedure can cause more harm and can even be life-threatening.

The main contraindications for which the puncture is not performed:

Puncture procedure

How is the preparation for the procedure going?

Preparation depends on the indications and nuances during the spinal puncture. Any invasive procedure requires diagnostic measures consisting of:

1. blood and urine tests;
2. diagnostics of blood properties, in particular, clotting indicators;

Important! The doctor must be informed about the medications taken, allergies and pathologies.

Be sure to stop taking all anticoagulants and angioplatelets a week before the planned puncture so as not to provoke bleeding. It is also not recommended to use anti-inflammatory drugs.

Women before x-rays with contrast should make sure that at the time of the puncture, there is no pregnancy. Otherwise, the procedure may adversely affect the fetus.

If the puncture is performed on an outpatient basis

Then the patient himself can come to the study. If he is being treated in a hospital, then he is brought from the department by medical personnel.

With self-arrival and departure, it is worth considering returning home. After the puncture, dizziness, weakness are possible, it would be good to use the help of someone.

No food or liquid should be consumed for 12 hours prior to the procedure.

The puncture can be assigned to children

The indications are similar in adulthood. However, infections and suspicions of malignant tumors account for the majority.

Without parents, the puncture is not performed, especially when the baby is scared. A lot depends on the parents. They are obliged to explain to the child why the procedure is performed, to inform about the pain, that it is tolerable and to calm.

As a rule, a lumbar puncture does not involve the introduction of anesthesia. Local anesthetics are used. This is done for better portability of the procedure. But, in case of an allergy to novocaine, you can completely refuse anesthesia.

When puncturing, when there is a risk of cerebral edema, it makes sense to administer furosemide 30 minutes before the needle is inserted.

The process of taking a puncture

The procedure begins with the patient taking the correct position. There are two options:

1. Lying. The person is placed on a hard table on the right side. At the same time, the legs are pulled up to the stomach and clasped with hands.
2. sitting, for example, on a chair. It is important in this position to bend your back as much as possible. However, this position is used less often.

The puncture is made in adults above the second lumbar vertebra, usually between 3 and 4. In children, 4 and 5 to minimize damage to the spinal tissue.

The technique of the procedure is not complicated if the specialist has been trained and, moreover, has experience. Compliance with the rules allows you to avoid terrible consequences.

Stages

The puncture procedure consists of several stages:

Training

The medical staff prepares the necessary tools and materials - a sterile needle with a mandrel (a rod for closing the lumen of the needle), a container for cerebrospinal fluid, and sterile gloves.

The patient takes the necessary position, the medical staff helps to further bend the spine and fix the position of the body.

The injection site is lubricated with iodine solution and then several times with alcohol.

The surgeon finds the right place, the iliac crest, and draws an imaginary perpendicular line to the spine. It is the right places that are recognized as the safest due to the absence of spinal cord substance.

Anesthesia stage

They are used to choose from - lidocaine, novocaine, procaine, ultracaine. It is introduced first superficially, then deeper.

Introduction

After anesthesia, a needle is inserted into the intended place with a cut up at an angle of 90 degrees relative to the skin. Then, with a slight inclination towards the head of the subject, the needle is very slowly inserted deep into.

On the way, the doctor will feel three needle failures:

1. skin puncture;
2. intervertebral ligaments;
3. sheath of the spinal cord.

After passing through all the dips, the needle has reached the intrathecal space, which means that the mandrin should be removed.

If the cerebrospinal fluid does not appear, then the needle should penetrate further, but this must be done with extreme caution due to the proximity of the vessels and to avoid bleeding.

When the needle is in the canal of the spinal cord, a special device - a manometer, determines the CSF pressure. An experienced doctor can determine the indicator visually - up to 60 drops per minute is considered the norm.

The puncture is taken in 2 containers - one sterile in the amount of 2 ml, necessary for bacteriological examination and the second - for the cerebrospinal fluid, which is examined to determine the level of protein, sugar, cellular composition, etc.

Completion

When the material is taken, the needle is removed, and the puncture site is sealed with a sterile napkin and adhesive tape.

The given technique for performing the procedure is mandatory and does not depend on age and indications. The accuracy of the doctor and the correctness of actions affect the risk of complications.

In total, the amount of fluid obtained during the puncture is no more than 120 ml. If the purpose of the procedure is diagnostics, then 3 ml is enough.

If the patient has a special sensitivity to pain, it is recommended to use sedatives in addition to anesthesia.

Important! During the entire procedure, the patient's mobility is not allowed, so the assistance of medical staff is required. If the puncture is performed on children, then the parent helps.

Some patients are afraid of puncture because of the pain. But, in reality, the puncture itself is tolerable and not terrible. Pain occurs when the needle passes through the skin. However, when the tissues are soaked with an anesthetic, the pain subsides and the area becomes numb.

In the case when the needle touches the nerve root, the pain is sharp, as with sciatica. But, this rarely happens and even refers more to complications.

When the cerebrospinal fluid is removed, a patient diagnosed with intracranial hypertension experiences a clear feeling of relief and relief from headache.

Recovery period

As soon as the needle is removed, the patient does not get up, but remains in a supine position for at least 2 hours on the stomach without a pillow. Children under 1 year old, on the contrary, are laid on their backs, but pillows are placed under the buttocks and legs.

The first hours after the procedure, the doctor observes the patient every 15 minutes with a condition control, because the cerebrospinal fluid can run out of the hole from the needle for up to 6 hours.

As soon as there are signs of swelling and dislocation of the brain sections, help is urgently provided

After the puncture procedure, bed rest must be observed. It is allowed to get up after 2 days at normal rates. If there are unusual changes, then the period may increase up to 14 days.

There may be headaches caused by a decrease in fluid volume and a decrease in pressure. In this case, analgesics are prescribed.

Complications

A lumbar puncture is always associated with risks. They increase if the algorithm of actions is violated, there is not enough information about the patient, in case of a serious state of health.

Possible but rare complications are:

If the procedure is carried out in compliance with all conditions, then undesirable consequences almost do not appear.

The stage of studying liquor

Cytological analysis is performed immediately on the same day as the lumbar puncture. When bacteriological culture and sensitivity assessment to antibiotics is necessary, the process is delayed for 1 week. This is the time to multiply the cells and evaluate the response to the drugs.

The material is collected in 3 tubes - for general analysis, biochemical and microbiological.

normal color cerebrospinal fluid clear and colorless, without erythrocytes. Protein is contained and the indicator should not exceed 330 mg per liter.

There is sugar in a small amount and red blood cells - in adults, no more than 10 cells per μl, in children a higher indicator is allowed. The normal density of cerebrospinal fluid is 1.005 to 1.008, pH is from 7.35-7.8.

If blood is observed in the received material, this means that either the vessel was injured, or there was a hemorrhage under the membranes of the brain. To clarify the cause, 3 test tubes are collected and examined. If the cause is a hemorrhage, then the blood will be scarlet.

An important indicator is the density of cerebrospinal fluid which changes with disease. If there is inflammation, then it rises, if hydrocephalus - decreases. If at the same time the pH level dropped, then most likely the diagnosis is meningitis or encephalitis, if it increased - brain damage with syphilis, epilepsy.

dark liquid speaks of jaundice or melanoma metastasis.

Cloudy cerebrospinal fluid is a bad sign indicating bacterial leukocytosis.

If protein is increased, then most likely we will talk about inflammation, tumors, hydrocephalus, brain infections.

Is such manipulation dangerous? What information can be obtained from this study?

The first thing to understand when it comes to puncture of the spinal cord (namely, as this procedure is most often called by patients), it does not mean a puncture of the tissue of the central nervous system organ itself, but only the sampling of a small amount of cerebrospinal fluid that washes the spinal cord and brain . Such a manipulation in medicine is called spinal, or lumbar, puncture.

Why is a spinal cord puncture done? The goals of such manipulation can be three - diagnostic, analgesic and therapeutic. In most cases, a lumbar puncture of the spine is done to determine the composition of the cerebrospinal fluid and the pressure inside the spinal canal, which indirectly reflects the pathological processes occurring in the brain and spinal cord. But specialists can perform a spinal cord puncture for a therapeutic purpose, for example, for the introduction of drugs into the subarachnoid space, to quickly reduce spinal pressure. Also, do not forget about such a method of anesthesia as spinal anesthesia, when anesthetics are injected into the spinal canal. This makes it possible to carry out a large number of surgical interventions without the use of general anesthesia.

Considering that in most cases spinal cord puncture is prescribed specifically for diagnostic purposes, it is this type of study that will be discussed in this article.

Why take a puncture

A lumbar puncture is taken to examine the cerebrospinal fluid, which makes it possible to diagnose certain diseases of the brain and spinal cord. Most often, such manipulation is prescribed for suspected:

• infections of the central nervous system (meningitis, encephalitis, myelitis, arachnoiditis) of a viral, bacterial or fungal nature;
• syphilitic, tuberculous lesions of the brain and spinal cord;
• subarachnoid bleeding;
• abscess of the central nervous system;
• ischemic, hemorrhagic stroke;
• traumatic brain injury;
• demyelinating lesions of the nervous system, such as multiple sclerosis;
• benign and malignant tumors of the brain and spinal cord, their membranes;
• Guienne-Barré syndrome;
• other neurological diseases.

The study of cerebrospinal fluid makes it possible to quickly diagnose severe diseases of the brain and spinal cord

Contraindications

It is forbidden to take a lumbar puncture with volumetric formations of the posterior cranial fossa or the temporal lobe of the brain. In such situations, taking even a small amount of CSF can cause dislocation of brain structures and cause infringement of the brain stem in the foramen magnum, which leads to immediate death.

It is also forbidden to carry out a lumbar puncture if the patient has purulent-inflammatory lesions of the skin, soft tissues, spine at the puncture site.

Relative contraindications are pronounced spinal deformities (scoliosis, kyphoscoliosis, etc.), as this increases the risk of complications.

With caution, puncture is prescribed to patients with impaired blood clotting, those who take drugs that affect blood rheology (anticoagulants, antiplatelet agents, non-steroidal anti-inflammatory drugs).

In case of brain tumors, a lumbar puncture can be performed only for health reasons, since the risk of developing dislocation of brain structures is high.

Preparation stage

The lumbar puncture procedure requires preliminary preparation. First of all, the patient is prescribed general clinical and biochemical blood and urine tests, the state of the blood coagulation system is necessarily determined. Examine and palpate the lumbar spine. To identify possible deformations that may interfere with the puncture.

Tell your doctor about all medicines you are currently taking or have recently taken. Particular attention should be paid to drugs that affect blood clotting (aspirin, warfarin, clopidogrel, heparin and other antiplatelet agents and anticoagulants, non-steroidal anti-inflammatory drugs).

You also need to inform the doctor about possible allergies to medications, including anesthetics and contrast agents, about recent acute illnesses, about the presence of chronic ailments, as some of them may be a contraindication to the study. All women of childbearing age should tell their doctor if they are pregnant.

Without fail, before performing a puncture of the spinal cord, the patient must consult a doctor

It is forbidden to eat for 12 hours before the procedure and drink for 4 hours before the puncture.

Puncture technique

The procedure is carried out with the patient in the supine position. In this case, it is necessary to bend the legs at the knee and hip joints as much as possible, bring them to the stomach. The head should be maximally bent forward and close to the chest. It is in this position that the intervertebral spaces expand well and it will be easier for the specialist to get the needle to the right place. In some cases, the puncture is performed with the patient in a sitting position with the most rounded back.

The place for the puncture is chosen by the specialist with the help of palpation of the spine so as not to damage the nervous tissue. The spinal cord in an adult ends at the level of the 2nd lumbar vertebra, but in people of short stature, as well as in children (including newborns), it is slightly longer. Therefore, the needle is inserted in the intervertebral space between the 3rd and 4th lumbar vertebrae or between 4th and 5th. This reduces the risk of complications after the puncture.

After treating the skin with antiseptic solutions, local infiltration anesthesia of soft tissues is performed with a solution of novocaine or lidocaine using a conventional syringe with a needle. After that, a lumbar puncture is performed directly with a special large needle with a mandrin.

What does a lumbar puncture needle look like?

A puncture is made at the selected point, the doctor directs the needle sagittally and slightly upward. At about a depth of 5 cm, resistance is felt, followed by a kind of needle failure. This means that the end of the needle has entered the subarachnoid space and you can proceed to the collection of CSF. To do this, the doctor removes the mandrin (the inner part that makes the instrument airtight) from the needle and cerebrospinal fluid begins to drip from it. If this does not happen, you need to make sure that the puncture is performed correctly and that the needle enters the subarachnoid space.

After collecting the CSF in a sterile tube, the needle is carefully removed, and the puncture site is sealed with a sterile bandage. Within 3-4 hours after the puncture, the patient should lie on his back or on his side.

The puncture is performed between the 3rd and 4th or 4th and 5th lumbar vertebrae

The study of cerebrospinal fluid

The first step in the analysis of cerebrospinal fluid is the assessment of its pressure. Normal indicators in a sitting position - 300 mm. water. Art., in the prone position - mm. water. Art. As a rule, pressure is estimated indirectly - by the number of drops per minute. 60 drops per minute corresponds to the normal value of CSF pressure in the spinal canal. Increased pressure in inflammatory processes of the central nervous system, with tumor formations, with venous congestion, hydrocephalus and other diseases.

Then the cerebrospinal fluid is collected in two test tubes of 5 ml. They are then used to carry out the necessary list of studies - physicochemical, bacterioscopic, bacteriological, immunological, PCR diagnostics, etc.

Depending on the results of the examination of the cerebrospinal fluid, the doctor can recognize the disease and prescribe the appropriate treatment.

Consequences and possible complications

In the vast majority of cases, the procedure passes without any consequences. Naturally, the puncture itself is painful, but the pain is present only at the stage of inserting the needle.

Some patients may develop the following complications.

Post-puncture headache

It is generally accepted that a certain amount of cerebrospinal fluid flows out of the hole after the puncture, as a result of which intracranial pressure decreases and headache occurs. Such pain resembles a tension headache, has a constant aching or squeezing character, decreases after rest and sleep. It can be observed for 1 week after the puncture, if cephalgia persists after 7 days - this is a reason to consult a doctor.

Traumatic complications

Sometimes traumatic complications of puncture can occur, when the needle can damage the spinal nerve roots, intervertebral discs. This is manifested by back pain, which does not occur after a correctly performed puncture.

Hemorrhagic complications

If large blood vessels are damaged during the puncture, bleeding and hematoma formation may occur. This is a dangerous complication that requires active medical intervention.

Dislocation complications

Occur with a sharp drop in CSF pressure. This is possible in the presence of volumetric formations of the posterior cranial fossa. To avoid such a risk, before taking a puncture, it is necessary to perform a study on signs of dislocation of the midline structures of the brain (EEG, REG).

Infectious complications

May occur due to violation of the rules of asepsis and antisepsis during the puncture. The patient may develop inflammation of the meninges and even form abscesses. Such consequences of a puncture are life-threatening and require the appointment of powerful antibiotic therapy.

Thus, spinal cord puncture is a very informative technique for diagnosing a large number of diseases of the brain and spinal cord. Naturally, complications during and after the manipulation are possible, but they are very rare, and the benefits of puncture far outweigh the risk of negative consequences.

Comments

Doctors should not be allowed to take this liquid.

Good afternoon, tell me the reason why you can’t give it. I have three children, they ended up in the hospital and three of them have a suspicion of meningitis, one child has confirmed what to do, tell me.

You can do! Do not listen to anyone, this is a completely safe diagnostic method. The main thing is an experienced doctor. And your positive attitude. I did it twice, 3 years apart. After the procedure, of course, it was hard, but you need to drink a lot of water (I drank 5 liters a day), bed rest, and after 5-7 days you will completely return to normal! But most of the people who lay with me in the ward tolerated it very well, though they complained of headaches, but this was because they didn’t drink water and were on their feet all day! And during the analysis, the main thing is to relax and follow all the instructions of the doctor. Do not worry and feel free to do everything to whom it was assigned. And be healthy!

How can you not allow such an analysis to be carried out if we are talking about establishing such a serious disease in a child as meningitis! There is no longer a choice, especially given the current outbreak of this disease. In most children admitted to the hospital with meningeal syndrome, after a puncture, it is confirmed. I myself am now in the infectious diseases hospital with my youngest daughter, it was confirmed with us and it’s scary to imagine what would have happened if we had not been hospitalized on time. Here, the entire hospital is packed, including the corridors, with children with the same diagnosis. Doctors themselves are shocked by this situation. And today the corpse of a one-year-old girl was brought to the hospital, yesterday the parents refused to be hospitalized, and today they simply did not have time to take it. Of course, a puncture is a procedure that God forbid anyone to experience, but if it concerns life and health, there should be no doubt.

Good afternoon! Vera, what city are you in, and where is the outbreak? My child and I are also in the hospital now with meningitis, we are already recovering! The puncture was taken already 3 times. There are absolutely no other options! And this is a very revealing analysis! Before the discharge will be taken again! The main thing is that everything turned out to be normal!

Hello! Tell me, we are going to have this analysis, and if meningitis is confirmed, then this disease can be treated?

How often can this procedure be performed?

• reply

Guest - 02.02.:02

And how do you feel about the fact that this procedure will be done by an intern and after a while you will start having problems with your back.

• reply

Guest - 02.02.:08

Not a single doctor admits to his mistake, if anything, moreover, with each intervention on the part of the clinic, we are obliged to sign consents to this, thereby removing all responsibility from the clinic if something goes wrong, but prove that you are not a camel, that’s our free Soviet medicine.

They said, if the choice is between putting the child in a coffin with meningitis or a puncture, which is risky by your standards, which will you choose?

On March 7, my son had a puncture, after the puncture he was sent to go to the ward, they didn’t tell him to lie down, he was on his feet, he was sitting. After 2 days, they said that the diagnosis of meningitis was not confirmed and we took him out of the infection. In the evening at home, in a sitting and standing position, his head and back began to ache, in the prone position the pain disappears. Today is March 12, but the pain has not yet passed, what should I do?

• reply

Guest - 13.03.:34

Julia, it looks like post-puncture syndrome. Doctors say - bed rest, and drink plenty of fluids to produce cerebrospinal fluid, for an adult 4 liters, for a child - ask the doctor.

It is believed that during the day should pass, i.e. the hole will be overgrown and the volume of the licorice will be replenished.

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What is a spinal cord puncture, does it hurt, possible complications

If we consider all existing types of diagnostic studies, then spinal cord puncture is considered to be one of the most complex research methods. Fluid sampling should be performed by a qualified surgeon, exclusively in a hospital.

What is a spinal tap

A spinal or lumbar puncture is a collection of CSF. During the procedure, despite the name, the spinal cord is not affected. For diagnostic studies, it is precisely the cerebrospinal fluid, the fluid surrounding the spinal canal, that is used.

Why do a puncture of the brain of the back

A lumbar puncture is performed with suspicion of the development of infectious diseases or oncological neoplasms. A diagnostic study is performed to confirm or clarify the diagnosis.

A puncture of the spinal cord is taken to measure the pressure in the spinal canal. The procedure may also introduce a marker (with MRI or CT using contrast) or a drug.

Preparing for a spinal tap

Special preparation of the patient for the puncture of the cerebrospinal fluid is not required. It is enough to find out about the presence of allergic reactions to painkillers. Local anesthesia is used during the procedure. Previously, the patient is given an allergy test and only after that they proceed to the procedure itself.

Does it hurt to take a spinal cord puncture?

The CSF collection procedure has been used for about 100 years. Initially, the puncture was done "alive", without the use of anesthetics, and therefore was painful. The modern technique of the sampling procedure involves the use of local anesthesia.

How to take a puncture

The patient is placed on the couch. The puncture site is cut off with anesthetics. After the anesthesia has worked, go directly to the procedure itself:

• The patient is placed on the couch. The position of the patient during spinal puncture is as follows: knees pressed to the stomach, chin to the chest. Anatomically, this position of the body leads to the extension of the processes of the spine and the unhindered introduction of the needle.

After the procedure

The collection of fluid for research takes only a few minutes. The patient after spinal puncture must be laid on a flat hard surface. The patient is advised to remain still for the first two hours.

• Headaches after a puncture - resemble the sensations that a person experiences during a migraine. Usually accompanied by nausea, sometimes vomiting. Pain is relieved by drugs of the NSAID group.

Recovery after puncture takes 2 days. Further hospitalization is prescribed according to indications, taking into account the patient's well-being.

Why is a spinal tap dangerous?

The danger of a puncture fence still exists. The patient and the doctor need to soberly assess the situation and possible negative effects due to the procedure.

• Anesthetic hit on the membrane of the spinal cord. Paralysis of the lower extremities develops, convulsions are observed.

Can something replace a lumbar puncture?

A complex algorithm for performing a spinal puncture and possible complications after the procedure have led to the fact that European clinics rarely resort to this type of research. But to clarify the diagnosis, a clinical examination of the cerebrospinal fluid may be required, so it is unrealistic to completely do without this diagnostic procedure.

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Puncture of the spinal cord

Puncture of the spinal cord (lumbar puncture) is a type of diagnosis that is quite complicated. The procedure removes a small amount of cerebrospinal fluid or injects drugs or other substances into the lumbar spinal canal. In this process, the spinal cord is not directly affected. The risk that arises during the 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:

• taking a small amount of CSF (cerebrospinal fluid). In the future, their histology is carried out;
• measurement of cerebrospinal fluid pressure in the spinal canal;
• removal of excess cerebrospinal fluid;
• injection of drugs into the spinal canal;
• relief of difficult childbirth in order to prevent pain shock, as well as anesthesia before surgery;
• determining the nature of the stroke;
• isolation of tumor markers;
• cisternography and myelography.

With the help of a lumbar puncture, the following diseases are diagnosed:

• bacterial, fungal and viral infections (meningitis, encephalitis, syphilis, arachnoiditis);
• subarachnoid bleeding (bleeding in the brain area);
• 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 identified with a bone marrow biopsy, but this statement is not entirely correct. During a biopsy, a tissue sample is taken for further testing. Access to the bone marrow is carried out through a puncture of the sternum. This method allows you to identify pathologies of the bone marrow, some blood diseases (anemia, leukocytosis, and others), as well as metastases in the bone marrow. In some cases, a biopsy can be performed in the process of taking a puncture.

For the prevention and treatment of DISEASES OF THE JOINTS, our regular reader uses the method of non-surgical treatment, which is gaining popularity, recommended by leading German and Israeli orthopedists. After carefully reviewing it, we decided to offer it to your attention.

Indications for spinal cord puncture

Without fail, a puncture of the spinal cord is performed for infectious diseases, hemorrhages, malignant neoplasms.

They take a puncture in some cases with relative indications:

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

Preparatory stage

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

Spinal puncture involves the following preparation:

1. Issuance of written consent to the manipulation.
2. The delivery of blood tests, with the help of which its coagulability is assessed, as well as the work 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 anamnesis of the disease, on recent and chronic pathological processes.

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

It is necessary to stop taking blood thinners, 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 need to provide information about the intended pregnancy. This information is necessary due to the expected X-ray examination during the procedure and the use of anesthetics, which may have an undesirable effect on the unborn child.

Your doctor may prescribe medication to take before your procedure.

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

Procedure technique

Do a puncture of the spinal cord in a hospital ward or treatment room. Before the procedure, the patient empties the bladder and changes into a hospital gown.

The patient lies on his side, bends his legs and presses them to his stomach. The neck should also be in a bent position, the chin pressed to the chest. In some cases, the spinal cord is punctured with the patient in a sitting position. The back should be as still 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 a local anesthetic drug. In some cases, a drug with a sedative effect may be used. Also during the procedure, the 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 the monitor and monitor the manipulation process.

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

CSF samples are sent to a laboratory study, where histology takes place directly.

The doctor begins to draw conclusions on the nature of the exit of the liquid and its appearance. In the normal state, the cerebrospinal fluid is transparent and flows out one drop per 1 second.

At the end of the procedure, you must:

• compliance with bed rest for 3 to 5 days on the recommendation of a doctor;
• keeping the body in a horizontal position for at least three hours;
• relief from physical activity.

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

Risks

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

• axial penetration;
• meningism (there are symptoms of meningitis in the absence of an inflammatory process);
• infectious diseases of the central nervous system;
• severe headache, nausea, vomiting, dizziness. The head may hurt for several days;
• damage to the roots of the spinal cord;
• 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, discharge at the puncture site, you should immediately consult a doctor.

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

Contraindications for spinal cord puncture

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

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

In each individual case, the doctor must analyze in detail the risk of 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 do a spinal cord puncture, but also carry out the procedure with minimal risk to the patient's health.

Do you often experience back or joint pain?

• Do you have a sedentary lifestyle?
• You cannot boast of a royal posture and try to hide your stoop under your clothes?
• It seems to you that it will soon pass by itself, but the pain only intensifies.
• Many methods have been tried, but nothing helps.
• And now you are ready to take advantage of any opportunity that will give you the long-awaited good health!

Spinal cord puncture: what complications can occur?

What is this method - puncture? This is a minimal intervention in the body, in which the doctor makes a puncture of tissues or bones to remove the desired material, followed by its examination.

True, it is carried out if other methods failed to establish or confirm the disease. Special needles are used here, which nullify the wounds at the injection site. All the action takes place exclusively in conditions of complete sterility, so as not to bring unnecessary "trouble". The place of the alleged puncture is planned, treated with an appropriate solution, and more than once, and only after that a puncture is made. The whole procedure takes no more than three minutes and is similar to the injection that many are used to. However, some discomfort "takes place" after removing the needle from the patient's body.

Puncture of the spinal cord - lumbar puncture - lumbar puncture. It is carried out both for the diagnosis of the disease and for the treatment. In other words: cerebrospinal fluid is taken for examination. This method has found the widest application in neurology. This puncture is performed on the lower back, under local anesthesia. This procedure is considered completely safe. Taking the cerebrospinal fluid for examination, you can determine its composition, learn everything about the inflammatory processes that occur, and at what stage of the lesion the nervous system is. The main task of this procedure is punctures - liquorodynamic samples, since they will make it possible to measure the pressure of the very fluid that was extracted. In turn, this will help, for example, to identify the cause of the patient's headaches.

You can ask those who have undergone this procedure: is it worth doing or not? The mother and child were admitted to the hospital in the infectious diseases department. Baby son is six months old. Couldn't make a correct diagnosis. The baby has a high temperature, which practically did not go astray. On the third day, a rash appeared and meningitis was suspected. Antibiotics were prescribed. Improvements were not observed, and on the fifth day regurgitation began, which became more frequent and intensified. Only after that a puncture was made and finally the diagnosis was revealed. No consequences were observed. Now, the child is completely healthy.

Another episode with a six-month-old baby. This girl was diagnosed with a terrible diagnosis - blood cancer. For several months, the parents, and especially the child, suffered because the treatment did not bring improvement. Finally took a puncture. A week later, this diagnosis was refuted. The girl is now three years old. Parents are convinced that such an analysis is essential, otherwise it is not known what could have happened to their child.

Two examples of answers to the question are described above: why do we need a spinal cord puncture, reviews of which are so encouraging.

Below is an example of the consequences of a spinal cord puncture.

A seven-year-old boy was admitted to the hospital, poisoned by tangerines or oranges. The diagnosis did not "loom", and the doctors took permission from the parents to collect cerebrospinal fluid. The poor child was injected several times, as a result, he was diagnosed with rheumatic syndrome. Appropriate treatment was prescribed and the boy was discharged a month later. But while still in the hospital, he had his first seizure. And it happened during sleep. The child began to choke, and the body convulsed. A few minutes and it's all over. These attacks were repeated, mostly at night. He was registered in a neurological dispensary. Appropriate treatment was prescribed, which lasted five years. Finally, the boy got tired of drinking these medicines and, without informing his parents, he simply stopped using them. At that time he was already 13 years old. The convulsions have stopped. What is it connected with? Most likely - outgrown. Why did they start so suddenly? The doctors did something wrong. The consequences were not long in coming.

This is the opposite example. So to do a puncture or not? What other consequences can be expected?

The main thing that the patient should do after this injection is to lie on his back for two hours without a pillow and continue to maintain the same position during the day. Many patients experience lethargy. They feel pain in the back, head. Since they are under the supervision of a doctor, they are provided with appropriate treatment. And, if everything was done correctly, then these unpleasant sensations pass soon enough.

And what is dangerous puncture? And what about the question: puncture of the spinal cord - complications are possible?

Can paralysis occur if the spinal cord is injured as a result of this procedure? Experts say that this is from the category of mythology. The fact is that this puncture is carried out on the lower back, where the spinal cord is no longer there. Therefore, there is nothing to touch.

Another misconception that "goes among the people" is an infection that can be "caught". It was said above how this procedure takes place, what conditions are met. Therefore, there is no point in talking about infection.

And the complications that can happen are the following: the possibility of bleeding; increased pressure in those patients who have brain diseases. However, the risk is negated if the puncture is performed by a highly qualified doctor.

If we consider all existing types of diagnostic studies, then spinal cord puncture is considered to be one of the most complex research methods. Fluid sampling should be performed by a qualified surgeon, exclusively in a hospital.

What is a spinal tap

The procedure has certain risks, but when a puncture is performed by a specialist, the likelihood of complications is minimized, and unpleasant symptoms completely disappear in the next few days.

Why do a puncture of the brain of the back

With the help of CSF sampling and clinical studies, it is possible to determine:

A puncture of the spinal cord is taken to measure the pressure in the spinal canal. The procedure may also introduce a marker (with MRI or CT using contrast) or a drug.

Puncture of the spinal cord is taken for diseases of an infectious and inflammatory nature: purulent meningoencephalitis, meningitis, myelitis, aneurysm ruptures, suspected tumors and hematomas.

An experienced surgeon can determine the patient's condition based on the external signs of cerebrospinal fluid. Under normal pressure, cerebrospinal fluid flows out at a rate of 1 drop per minute and is colorless. Any deviations indicate the presence of adverse pathological processes.

Preparing for a spinal tap

Recently, the question of the need for psychological preparation of a person for the collection of cerebrospinal fluid has been increasingly raised. Some patients are very worried about the procedure. The task of the specialist is to create a favorable relaxing atmosphere. It is especially important to create such conditions so as not to injure the psyche of children.

Does it hurt to take a spinal cord puncture?

Although the puncture itself is practically painless, the patient will experience some discomfort during the puncture. The task of the specialist is the need to warn about this, since during the procedure the patient will need a certain amount of time to remain still.

How to take a puncture

• The patient is placed on the couch. The position of the patient during spinal puncture is as follows: knees pressed to the stomach, chin to the chest. Anatomically, this position of the body leads to the extension of the processes of the spine and the unhindered introduction of the needle.
• Disinfection of the CSF collection area is carried out. The place is treated with iodine and alcohol.
• Carry out a puncture. There is a special needle for lumbar puncture. Its length is 6 cm. The use of reusable needles is not allowed. A lumbar puncture is taken between the third and fourth vertebrae. In newborns, fluid is taken from the upper part of the tibia.
• The needle is pulled out, the puncture site is sealed with a special plaster.

After the procedure

Immediately after the procedure, the following side effects are possible:

• Headaches after a puncture - resemble the sensations that a person experiences during a migraine. Usually accompanied by nausea, sometimes vomiting. Pain is relieved by drugs of the NSAID group.
• Weakness - the body is trying to make up for the lack of cerebrospinal fluid, so the patient experiences bouts of lethargy, often accompanied by bouts of pain in the puncture area.

Why is a spinal tap dangerous?

The following complications and consequences of spinal cord puncture are observed:

• Anesthetic hit on the membrane of the spinal cord. Paralysis of the lower extremities develops, convulsions are observed.
• Increased load on the brain. A contraindication for lumbar puncture is massive hemorrhage. The liquid begins to flow out under high pressure. There is a shift in the brain. As a result, the nerve center responsible for the respiratory functions of the body is impaired.
• Failure to comply with the conditions of rehabilitation after puncture. Failure to comply with bed rest for the entire period required for recovery can cause serious complications.

A puncture can be taken no more than 1 time within six months. Experts recommend resorting to this procedure only in extreme cases, when other types of studies have not yielded results.

Can something replace a lumbar puncture?

Modern research methods have made it possible to minimize possible risks, discomfort and recovery time after puncture. Therefore, subject to competent medical personnel, fluid sampling is practically safe.

Lumbar puncture of the spinal cord is performed at the lumbar level of the spinal column. During the operation, a needle is inserted between several vertebrae of the lumbar spine to obtain a sample of cerebrospinal fluid. This is required for anesthetic or therapeutic purposes, that is, when an area is anesthetized or any medical procedures are required.

Thanks to the puncture of the bone marrow, it is possible to detect:

1. meningitis.
2. Neurosyphilis.
3. Various CNS disorders.
4. Abscess.
5. Multiple demyelinating sclerosis.
6. All kinds of cancer of the spinal cord and brain.

In some cases, a bone marrow puncture is used to administer painkillers. This is mainly required when chemotherapy is given.

What is required

1. The need for spinal cord fluid for examination.
2. Finding out the pressure in the fluid of the spinal cord.
3. Cisternography and myelography.
4. Introduction of a chemotherapeutic drug and drug solution.

The patient is injected with pigment solutions or radioactive compounds to obtain a clear image of the fluid jet.

Thanks to the results of the analyzes, it is possible to detect:

1. Dangerous microbes, fungal and viral infections, in particular syphilis, meningitis and encephalitis.
2. Hemorrhages in the subarachnoid cerebral space (SAH).
3. Some types of cancer that originate in the spinal cord and brain.
4. Most of the inflammation of the central nervous system, for example, multiple sclerosis, acute polyradiculitis and various paralysis.

Consequences and risks

Bone marrow puncture is a rather dangerous event. Its correct taking is carried out only by a qualified doctor who has specialized tools and deep knowledge.

Negative consequences and complications are:

1. headaches;
2. discomfort;
3. bleeding;
4. increased intracranial pressure;
5. formations of hernias;
6. development of cholesteatoma.

Taking into account the current clinical picture, specialists recommended that during the first few days after the puncture, maintaining a sedentary lifestyle and maintaining bed rest.

Regarding the appearance of unrelenting pain in the spine, this is a fairly common ailment experienced by patients. The pain is localized both at the puncture site and spreads down the back of the legs.

Contraindications

The procedure is not applied in case of suspicion or detection of brain dislocation, as well as in the presence of stem symptoms.

If the pictorial pressure in the spiral volume drops, then the puncture is not done, since very dangerous consequences are possible. It triggers the mechanism of infringement of the brain column, due to which the operation can lead to the death of the patient.

Particular care is taken when performing the procedure in violation of blood clotting, a tendency to bleeding, as well as taking drugs that thin the blood. These include:

1. clopidogrel;
2. warfarin;
3. some commercial analgesics, such as naproxen sodium or aspirin.

How is the procedure performed

A spinal cord puncture is performed in a clinic or in a hospital setting. Before the procedure, the patient's back is washed with antiseptic soap, disinfected with alcohol or iodine, and then covered with a sterile napkin. The site where the puncture will be made must be decontaminated with an effective anesthetic.

This procedure is done between the 3rd and 4th or 4th and 5th vertebrae. The curve that outlines the top of the ilium vertebral bone serves as a guide for the interspinous space.

The patient is placed in a horizontal position on the right or left side. Thus, he should lie down in the fetal position. The skin in the area where the puncture will be made is treated with alcohol or iodine. In addition, the puncture site requires anesthesia by introducing novocaine solution under the skin.

While anesthesia is in effect, the specialist performs a puncture of the intrathecal space using a medical needle with a mandrel, the length of which is about 10-12 cm, and the thickness is 0.5-1 mm. The needle is inserted strictly in the sagittal plane and directed slightly upward, that is, in accordance with the tiled location of the spinous formation.

The needle, in the course of approaching the hypothecal space, will experience resistance from what comes into contact with the honeysuckle and yellow ligament, the fiber layer of fatty deposits is easily overcome and meets resistance when the strong meninges pass.

When a puncture occurs, the doctor and the patient feel as if the needle is falling through. This phenomenon is quite normal, do not be afraid. The needle moves forward a few millimeters and the mandrin is removed from it. After that, CSF should begin to flow from the needle. In the normal state, the liquid is clear and flows out in meager drops. To measure the pressure in the cerebrospinal fluid, modern manometers are used.

It is impossible to draw out the cerebrospinal fluid with a syringe, as this leads to infringement of the trunk and dislocation of the brain.

After the pressure has been determined and the cerebrospinal fluid is taken, the needle is removed, and the puncture zone is sealed with a sterile patch. Take cerebrospinal fluid for about 45 minutes. The patient after the puncture should be in bed for at least a day.

What happens after

Patients are prohibited from performing active and strenuous work on the day when the procedure is performed. Return to normal life is possible only after the permission of the treating specialist.

After the puncture, a large number of patients are recommended to take painkillers to help relieve headaches and pain at the puncture site.

The sample of fluid that was removed by puncture is placed in a box and taken to the laboratory for analysis. The laboratory assistant, thanks to research activities, finds out:

1. index of cerebrospinal fluid;
2. protein concentration;
3. the concentration of white blood cells;
4. the presence of microorganisms;
5. the presence of mutilated and cancerous cells in the sample.

What indicators should have cerebrospinal fluid in a normal state? A good result will be characterized by the transparency and colorlessness of the liquid. In the event that the sample has a yellowish, dull or pinkish color, then this means the presence of infection.

If the protein exceeds the normal value, then this may indicate poor health of the patient, as well as the fact that inflammation has begun to develop. In the event that the protein content exceeds the level of 45 mg / dl, then the presence of infections and destructive processes is possible.

Equally important is the concentration of white blood cells. The sample in the normal state contains no more than 5 mononuclear leukocytes. If their number grows, then this indicates the presence of infection.

Pay attention to glucose concentration. Due to the low level of sugar in the sample taken, the presence of infection and other pathological processes is confirmed.

If microbes, viruses, fungi and other microorganisms were found, then this indicates the presence of infection.

If cancerous, mutilated, or immature blood cells were found, then this may confirm the presence of some type of cancer.

A puncture is a surgical manipulation that is performed as a diagnostic or therapeutic procedure. Puncture literally translates as "puncture" and this is the simplest characteristic of this procedure.

Types of punctures

All types of punctures can be divided into two types:

. Punctures are diagnostic or therapeutic manipulations, the purpose of which is to obtain or extract fluids from various organs and tissues of the human body. With the help of this procedure, liquid, pus, exudate are obtained for further histological examination and an accurate determination of the nature and type of the disease, the type of pathogenic microorganisms and pathogens.

A biopsy is a similar procedure in which tissues of a diseased organ are taken for the purpose of further study at the biological cellular level. To establish the type and nature of tumors and other pathologies, such a diagnosis is considered the most informative and reliable.

In modern clinical practice, puncture and biopsy of almost all types of tissues and internal organs are performed, including blood and lymphatic vessels, bone marrow, cerebrospinal and synovial fluid. For a clear understanding of the essence of the puncture, we can cite as an example the collection of venous blood for laboratory research. Such a procedure in medical terminology is called venipuncture, that is, the puncture of a venous vessel to obtain fluid, in this case blood. Is a puncture dangerous? And what are the complications and consequences of this procedure? To answer this question, it is necessary to understand at least in general terms how the procedure itself takes place, how preparation is carried out, what happens during and after it.

Puncture technique

Indications for prescribing a diagnostic puncture to a patient are determining the presence of fluid, assessing its nature and the type of microorganisms in its composition (bacterioscopic and bacteriological examination), determining its composition (cellular and chemical). Diagnostic puncture is prescribed for inflammatory processes, dropsy, ascites, diseases that are accompanied by accumulation of fluid (exudate), accumulations of pus in organs or body cavities.

Lumbar - produced by a doctor to extract, as well as obtain cerebrospinal fluid for laboratory analysis and study of its composition. In addition, this procedure is performed for medicinal purposes to reduce spinal pressure. Puncture is essentially a surgical intervention. For this reason, when carrying out this procedure, it is necessary to follow all the rules as much as possible (especially for antiseptics). And then the answer to the question Is a puncture dangerous??" will be negative!

Before the puncture, a thorough sterilization of the syringe and a set of needles for the procedure is carried out. The patient's skin in the manipulation area is lubricated with iodine. When performing a puncture using a thick needle, local anesthesia is performed on the skin by injecting a 0.25% solution of novocaine. After such preparation, the procedure itself begins directly. It is performed by inserting a needle into the skin at a right angle to its surface. After reaching the area under study, the doctor fixes the needle with the thumb and forefinger, while gently pulling the syringe plunger.

If no liquid enters the syringe, then the doctor moves the needle a little deeper, and so it is manipulated until the liquid appears. When manipulating the needle, the doctor should be guided by his knowledge of the anatomical structure of the area under study and the data obtained from the preliminary examination of the individual characteristics of the patient. When performing a puncture, it is very important to be confident in the high qualification and experience of the doctor, since when a needle is inserted, there is a theoretical threat of violating the integrity of large blood vessels. For this reason, the answer to the question of whether a puncture is dangerous directly depends on confidence in the skills, knowledge and skills of a specialist.

If you are looking for the best doctor for diagnosing puncture and biopsy methods, contact our medical center. Here you can undergo all types of diagnostics from highly qualified surgeons with extensive experience. Our specialists of our center have proved their highest professionalism over the years of successful practice.