Lumbar Puncture Archives

What types of needle tips are available on spinal needles and what are their advantages and disadvantages?

Needle Type Cutting Atraumatic Examples QuinckeAtraucan SprotteWhitacreBallpen Advantages Cuts through tissue and ligaments, making insertion easierAperture at the tip of the needle, so less likely to straddle the dural membrane if injecting medication - reduces the...

Which interspace should a lumbar puncture be performed at and how can this be identified?

Lumbar puncture should not be performed at or above the L2/3 interspace: In adults, the solid spinal cord ends at L1 (ranges from T11 to upper L3) At this level the conus medullaris continues distally as the cauda equina Puncture above this level risks damaging the...

What are the complications of lumbar puncture?

Immediate FailureBloody tapNerve root pain Early Post-dural puncture headache (PDPH)Post-dural puncture herniation (very rare)Spinal / epidural haematomaSpinal cord ischaemiaNerve damage (temporary or permanent)Infection:Local injection siteEpidural abscessMeningitis...

What are the contraindications to performing a lumbar puncture?

Absolute Space occupying lesion with mass effect and evidence of increased ICP:Risk of cerebral herniationSuggested by midline shift or loss of cisterns on CTPosterior fossa massArnold-Chiari malformationCoagulopathy (see BSN Guidance):Platelets <40,000INR...

What are the indications for performing a lumbar puncture?

Diagnostic Investigate meningoencephalitisInvestigate neurological disorders:Multiple SclerosisGuillain BarreMitochondrial DisordersParaneoplastic SyndromesInvestigate subarachnoid haemorrhageInvestigate disorders of intracranial pressureAdminister diagnostic...