Spinal Tap (lumar Puncture)

[Guest allan]

Spinal Headaches

A spinal headache can occur as a result of a procedure such as a spinal tap (lumbar puncture) or epidural block (such as that performed during a womans labor and delivery). In these procedures, a needle is placed within the fluid-filled space surrounding the spinal cord. This creates a passage for the spinal fluid to leak out, changing the fluid pressure around the brain and spinal cord. If enough of the fluid leaks out, a spinal headache may develop.

Because the design of spinal needles has been improved, spinal headaches after a spinal tap or administration of spinal anesthesia are rare. When epidural anesthetics are placed with a larger needle than that used for spinal anesthetics, however, the likelihood of headache is higher if the epidural needle should inadvertently pass through the dura matter (covering of the spinal cord).

A spinal headache may occur up to five days after the procedure is performed. Such a headache may be prevented with bed rest after a procedure.

What Are the Symptoms of a Spinal Headache?

The spinal headache often is described as "a headache like no other." Spinal headaches are much more severe when the person is in an upright position; they improve when the person lies down.

How Are Spinal Headaches Treated?

The first course of treatment for spinal headaches involves supplying adequate hydration to try to increase cerebral spinal fluid (CSF) pressure. Sometimes intravenous fluids (fluids administered into the veins) are given; other times the person is advised to drink a beverage high in caffeine. Strict bed rest for 24-48 hours is also recommended.

In addition, if a person develops a spinal headache following a procedure, the anesthesiologist can create a blood patch with the person's blood to seal the leak. To administer a blood patch, the anesthesiologist inserts a needle into the same space as, or right next to, the area in which the anesthetic was injected. The doctor then takes a small amount of blood from the patient and injects it into the epidural space. The blood clots and seals the hole that caused the leak.

Reviewed by the doctors at The Cleveland Clinic Pain Management Department.

Edited by Charlotte E. Grayson, MD, June 2004..

Portions of this page © The Cleveland Clinic 2000-2003

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[Guest allan]

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Lumbar Puncture (LP)

What is a lumbar puncture (LP)?

Why is a lumbar puncture done?

How is the LP performed?

What is done next?

What is the cerebrospinal fluid (CSF)?

What is normal CSF?

What diseases are diagnosed by examination of the CSF?

What are the risks of an LP?

What are the benefits of an LP?

What is a lumbar puncture (LP)?

A lumbar puncture (an LP) is the insertion of a needle into the fluid within the spinal canal. It is termed a "lumbar puncture" because the needle goes into the lumbar portion (the "small") of the back.

Other names for a lumbar puncture (an LP) include spinal tap, spinal puncture, thecal puncture, and rachiocentesis.

Why is a lumbar puncture done?

An LP is most commonly peformed to diagnose a disease, namely to obtain a sample of the fluid in the spinal canal (the cerebrospinal fluid) for examination.

An LP can also be done to treat diseases. For example, as a way of administering antibiotics, cancer drugs, or anesthetic agents into the spinal canal. Spinal fluid is sometimes removed by LP for the purpose of decreasing spinal fluid pressure in patients with uncommon conditions (such as, for examples, normal-pressure hydrocephalus and benign intracranial hypertension).

How is the LP performed?

The patient is typically lying down sideways for the procedure. Less often, the procedure is performed while the patient is sitting up. LPs in infants are often done upright.

After local anesthesia is injected into the small of the back (the lumbar area), a needle is inserted in between the nearby bony building blocks (vertebrae) into the spinal canal. (The needle is usually placed between the 3rd and 4th lumbar vertebrae).

What is done next?

Spinal fluid pressure can then be measured and cerebrospinal fluid (CSF) removed for testing.

What is the cerebrospinal fluid (CSF)?

The CSF circulates around the brain and spinal cord (the central nervous system). This "water bath" acts as a support of buoyancy for the brain and spinal cord. The support of the CSF helps to protect the brain from injury.

The normal CSF contains various chemicals, such as protein and sugar (glucose), and few if any cells. The spinal fluid also has a normal pressure when first removed.

What is normal CSF?

Normal values for spinal fluid examination are as follows:

Protein (15-45 mg/dl)

Glucose (50-75 mg/dl)

Cell count (0-5 mononuclear cells)

Initial pressure (70-180 mm)

These normal values can be altered by injury or disease of the brain, spinal cord or adjacent tissues. The values are routinely evaluated during examination of the spinal fluid obtained from the lumbar puncture. Additionally, spinal fluid is tested for infection in the microbiology laboratory.

What diseases are diagnosed by examination of the CSF?

Spinal fluid obtained from the lumbar puncture can be used to diagnose many important diseases such as bleeding around the brain; increased pressure from hydrocephalus; inflammation of the brain, spinal cord, or adjacent tissues (encephalitis, meningitis); tumors of brain or spinal cord, etc. Sometimes spinal fluid can indicate diseases of the immune system, such as multiple sclerosis.

What are the risks of an LP? When spinal fluid is removed during an LP, the risks include headache, brain herniation, bleeding, and infection. Each of these complications are uncommon with the exception of headache, which can appear from hours to up to a day after LP. Headaches occur less frequently when the patient remains lying flat 1-3 hours after the procedure.

What are the benefits of an LP?

The benefits of the LP depend upon the exact situation for which it is performed, but an LP can provide lifesaving information.

Reference:

Harrison's Principles of Internal Medicine, McGraw-Hill, edited by Eugene Braunwald, et. al., 2001.

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[otey2171]

Last night I went to the local ER, not the VA, for my persistent headache. The doc gave me fentanyl for the pain and told me to come back today so a anesthesiologist could give me a blood patch to stop the csf leak. I woke up this morning and the headache is gone. B)

[Guest allan]

glad to hear your feeling better.

If standard health care practices were followed, you wouldn't have suffered all those hours. I'm sorry you had to experience that. It's a terribly painful headache.

[Guest Dataman]

Good Move. You got to hit it with a Big Hammer. That is a good choice. What I would have asked for.

Get Well!