Spinal puncture

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A spinal puncture, also called a spinal tap, lumbar puncture, or LP is "tapping of the subarachnoid space in the lumbar region, usually between the third and fourth lumbar vertebrae.[1][2][3][4]

Procedure

Use of an 'atraumatic needle' may reduce the chance of headache, although this needle is more difficult to use and may increase the number attempts needed before successful puncture.[2] Reinsertion of the stylet before needle removal decreases headache.[2]

Measurement of CSF pressure

The normal opening pressure is 6 to 18 cm of H2O or 0.4 to 1.3 cm Hg (mercury is 13.6 times more dense than water).[2] To accurately measure the opening pressure of the cerebrospinal fluid:

  • The patient should be laying (not sitting)[5][6] Sitting may increase the pressure by 40 cm H2O.[7] In the sitting position, CSF pressure ranges from 32 to 63 cm H2O with a mean of 49 cm H2O.[8]
  • The patient's neck should be relaxed as fully flexing the neck ('chin on chest') can raise pressure by 12 cm H2O[9][10] This may be due to the patient inadvertently performing Queckenstedt's maneuver or similar. Flexing the neck to only 30° may not matter.[11]
  • The position of the lower extremities does not matter.[11]

References

  1. ↑ Anonymous, (2009) Spinal puncture (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ 2.0 2.1 2.2 2.3 Straus SE, Thorpe KE, Holroyd-Leduc J (October 2006). How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis?. JAMA 296 (16): 2012–22. DOI:10.1001/jama.296.16.2012. PMID 17062865.
  3. ↑ Ellenby MS, Tegtmeyer K, Lai S, Braner DA (September 2006). Videos in clinical medicine. Lumbar puncture. N. Engl. J. Med. 355 (13): e12. DOI:10.1056/NEJMvcm054952. PMID 17005943.
  4. ↑ Marton KI, Gean AD (1986). The spinal tap: a new look at an old test.. Ann Intern Med 104 (6): 840-8. PMID 3518565.
  5. ↑ Becht FC (1920) Studies on the cerebrospinal fluid. Am J Physio 1920;51(1):1-125**
  6. ↑ Loman J, Myerson A, Goldman D. Effects of alterations in posture on the cerebrospinal fluid pressure. Arch Neurol Psych. 1934:1279-1295.**
  7. ↑ Magnaes B (1976). Body position and cerebrospinal fluid pressure. Part 1: clinical studies on the effect of rapid postural changes.. J Neurosurg 44 (6): 687-97. DOI:10.3171/jns.1976.44.6.0687. PMID 1271089. **
  8. ↑ Magnaes B (1976). Body position and cerebrospinal fluid pressure. Part 2: clinical studies on orthostatic pressure and the hydrostatic indifferent point.. J Neurosurg 44 (6): 698-705. DOI:10.3171/jns.1976.44.6.0698. PMID 1271090.
  9. ↑ Dinsmore J, Bacon RC, Hollway TE (1998). The effect of increasing degrees of spinal flexion on cerebrospinal fluid pressure.. Anaesthesia 53 (5): 431-4. PMID 9659014.
  10. ↑ Deliyannakis E (1971). Influence of the position of the head on the cerebrospinal fluid pressure. Variations of the Queckenstedt sign.. Mil Med 136 (4): 370-2. PMID 5005427. **
  11. ↑ 11.0 11.1 Abbrescia KL, Brabson TA, Dalsey WC, Kelly JJ, Kaplan JL, Young TM et al. (2001). The effect of lower-extremity position on cerebrospinal fluid pressures.. Acad Emerg Med 8 (1): 8-12. PMID 11136140.
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