A lumbar puncture (LP), also referred to as a spinal tap, is a medical procedure used to extract spinal fluid from the spinal canal for diagnostic purposes. This technique is especially useful for identifying inflammatory conditions of the nervous system, particularly infections such as meningitis. It can also aid in diagnosing tumors and cancers within the central nervous system. The term "lumbar puncture" originates from the fact that the needle is inserted into the lumbar region, or lower back. Other names for this procedure include spinal puncture, thecal puncture, and rachiocentesis.Primarily, an LP is performed to collect a sample of cerebrospinal fluid (CSF) for analysis. Besides diagnostics, it can also be used therapeutically to administer medications like antibiotics or chemotherapy agents directly into the spinal canal. Additionally, spinal fluid may be withdrawn to alleviate pressure in rare conditions such as normal-pressure hydrocephalus or idiopathic intracranial hypertension.Typically, the patient lies on their side during the procedure, though occasionally it may be conducted with the patient sitting up, particularly in infants where it is often done in an upright position. After administering a local anesthetic to the lumbar area, a needle is introduced between the vertebrae into the spinal canal, usually between the third and fourth lumbar vertebrae. This allows the measurement of spinal fluid pressure and the collection of CSF for testing.Cerebrospinal fluid circulates around the brain and spinal cord, providing a cushioning effect that protects these structures from injury. Normally, CSF contains specific levels of chemicals such as proteins and glucose, and minimal cell presence, while maintaining standard pressure. Typical values for CSF examination include protein levels of 15-45 mg/dl, glucose levels of 50-75 mg/dl, a cell count of 0-5 mononuclear cells, and an initial pressure of 70-180 mm. These can be altered by injuries or diseases affecting the brain, spinal cord, or surrounding tissues.The analysis of spinal fluid obtained from an LP can reveal critical information about various diseases, such as brain hemorrhages, increased hydrocephalus pressure, brain or spinal cord inflammation (e.g., meningitis), and tumors. Occasionally, LP results can also suggest other conditions affecting the nervous system.While performing an LP, potential risks include headaches, brain herniation, bleeding, and infection. Headaches are the most common side effect, often occurring within a few hours to a day after the procedure. Lying flat for 1-3 hours post-procedure can reduce the likelihood of headaches. Despite these risks, the information gained from an LP can be vital and even life-saving, depending on the specific clinical scenario.
