Lumbar Puncture (LP or Spinal Tap)
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
- What is a lumbar puncture (LP)?
- Why is a lumbar puncture done?
- How is the LP procedure performed?
- What is the cerebrospinal fluid (CSF)?
- What is normal CSF?
- What diseases are diagnosed by examination of the CSF?
- What are possible risks, complications, or side effects of a lumbar puncture?
- What are the benefits of a lumbar puncture?
What is a lumbar puncture (LP)?
A lumbar puncture (LP) is the insertion of a needle into the fluid within the spinal canal to collect and examine the fluid that surrounds the brain and spinal cord (cerebral spinal fluid). It is termed a "lumbar puncture" because the needle is placed in the lumbar portion of the back and used to puncture through tissues to enter the spinal canal.
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 performed to obtain a sample of the fluid that surrounds the brain and spinal cord. Examination of the fluid can be crucial in diagnosing diseases such as meningitis, neurologic diseases, or effects of systemic disease on the brain and spinal fluid. An LP can also be done to treat diseases, 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, normal-pressure hydrocephalus and benign intracranial hypertension, for example).
Sometimes a lumbar puncture is performed in patients with migraines to assure that no other underlying pathology exists.
How is the LP procedure performed?
The patient is typically lying down on their side for the procedure. Less often, the procedure is performed while the patient is sitting up and leaning slightly forward.
After local anesthesia is injected into the lumbar area of the back , a long needle is inserted in between the bones of the spine (vertebrae) into the spinal canal. (The needle is most commonly placed between the third and fourth lumbar vertebrae.)
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 (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 normally appears clear and contains various substances, such as protein and sugar (glucose), and few if any cells. The spinal fluid also has a normal pressure when first removed.
Next: What is normal CSF?
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