The lumbar puncture to obtain liquor
The lumbar puncture is a procedure for collecting nerve fluid (Liquor). The derivation of the word lumbar puncture reveals a lot about the implementation of this procedure. The word "lumbal" comes from the Latin word lumbus, which means loin. A puncture is therefore carried out in the lumbar region or the lumbar spine. Puncture is the process of inserting a special needle into a cavity in a blood vessel or organ.
In the case of a lumbar puncture, a needle is inserted into the area of the lumbar spine to extract brain / nerve water that flows around the spinal cord.
Read more on the topic CSF diagnostics
Indication / purpose
The lumbar puncture is used Collection of liquor. Its composition is then further examined in the laboratory in order to draw conclusions about possible neurological diseases. It is determined which proportions of cells are present in which concentration, because deviations from the normal concentration can allow conclusions to be drawn about the cause of the suffering. For example, can bacteria detected in the CSF, which can cause inflammation of the nerves and the brain. In the case of inflammation, there are also more White blood cells (Leukocytes), which can be determined in the CSF by a laboratory examination.
Furthermore, the Sugar value (glucose) can be determined in the cerebral and nervous water. This value is for example lower for inflammation than in healthy patients.
Consequently, a diagnostic indication of lumbar puncture is the detection of inflammatory diseases of the central nervous system, such as, for example Meningitis (meningitis), one Encephalitis (Encephalitis) or the multiple sclerosis (MS).
Lumbar puncture in multiple sclerosis
An important part in addition to physical exams and imaging tests Diagnosis and follow-up of multiple sclerosis (MS) is the lumbar puncture and the associated CSF examination. In patients who suffer from MS, the components of the cerebrospinal fluid change compared to patients who do not have MS, so that certain antibodies (part of the body's immune system) and proteins are found in the cerebrospinal fluid.
The diagnosis “MS” is made together with the medical history and the physical examination for the presence of certain antibodies in certain concentrations in the CSF.
Lumbar puncture in the child
The indications for a lumbar puncture in children are similar to those in adults. However, the way the lumbar puncture is performed varies depending on the age of the child. In children, the CSF puncture can also be performed in Lie or Sit be performed. A special feature, however, is that the puncture to obtain liquor is not only possible in the Lumbar region, so can be performed lumbar, but also directly between the first cervical vertebra and the skull (Suboccipital puncture) with the chin pointing towards the chest.
This examination is also carried out in children sedative and numbing medicines carried out. It is very important that the lumbar puncture is performed in the presence of the parents so that the children are calmer and less afraid.
But you can also Bleeding be detected with the lumbar puncture, because then one finds blood or free hemoglobin (part of the red blood cells) in the puncture. Normally, blood components and components of the CSF should pass through the Blood-liquor barrier be strictly separated, a deviation or a disruption of this barrier can also be detected by a lumbar puncture.
The lumbar puncture is also used if one suspects one Tumor disease because tumor cells can also be found in the CSF.
Another indication for a lumbar puncture is the suspicion of one Pressure increase in the brain. Similar to blood pressure, the liquor is also subject to a limit that is healthy for humans. Deviations from the healthy norm can be determined by measuring the CSF pressure.
In summary, one can say that the CSF puncture is a diagnostic Has value. However, a CSF puncture is also possible therapeutic Important in everyday life, especially when drugs have to work in the central nervous system and cannot reach their target site because of the blood-brain barrier. In this case, drugs (chemotherapy drugs, antibiotics, pain medication in the Epidural anesthesia) are injected into the liquor via the lumbar puncture and thus reach their target site.
In conclusion, one can say that the lumbar puncture is used for Detection and therapy of diseases can apply.
Procedure / implementation
Before the lumbar puncture, a blood sample is taken, during which the blood clotting is checked. It is also checked whether there is increased intracranial pressure. If there is impaired blood coagulation and increased intracranial pressure, one should avoid the lumbar puncture.
The withdrawal of brain water is carried out in the Lumbar spine area carried out, more precisely between the third and fifth lumbar vertebraebecause you can no longer injure the spinal cord at this point and there is a lot of liquor there. The procedure is carried out while sitting while the patient bends the upper body forward or laying also with a slightly curved back. In this position, the space between the vertebrae is greatest and the blood vessels are compressed, which reduces the risk of bleeding.
The lumbar puncture is an operation that can be painful under certain circumstances, which is why the affected area optionally with a local anesthesia can be supplied. However, since this only occurs very rarely, local anesthesia is often not used. Alternatively, the patient can also have a sedative drug take, which loosens the muscles and has a general calming and anxiolytic effect. In any case, a thorough one is important disinfection of the skin area and the sterile implementation the withdrawal of the brain water. When the local anesthetic is effective, a hollow needle is used to pierce the skin, the ligaments that hold the spine and the meninges that line the space around the spinal cord. Once these structures have been overcome, the closure that clogs the needle from the inside is pulled back so that the cerebral fluid can drain out. Mostly will several samples of one to two milliliters taken.
It is not necessary to sew up the tiny wound afterwards as it will close closes by itself. However, one should sterile bandage applied and the wound checked at regular intervals and kept sterile bandaged so that there is no infection.
Duration of the lumbar puncture
The lumbar puncture is usually a relative one short intervention of about 30 minutes, with preparation and follow-up, which can also be carried out on the bed in the patient's room. A thorough working method is required to prevent the spread of germs and other complications. If the cerebrospinal fluid does not drain off immediately, the procedure is somewhat longer.
Risks / side effects
Of course, every intervention also involves a risk. The doctor performing the procedure will do everything possible to avoid possible side effects. If the procedure is carried out correctly, the risks are very low.
In general, however, symptoms can occur after the lumbar puncture. These include a headache, especially if patients have had frequent headaches or migraines in the past. In this case, the headache resulted from the puncture creating a negative pressure. Most of the time, the associated pain is localized at the back of the head and occurs particularly when changing from lying down to sitting or standing upright. These headaches are not dangerous because they usually go away in less than 24 hours or after a few days with no long-term consequences.
Rare can it become a temporary hearing loss come. The preliminary examinations should rule out increased intracranial pressure, but if the intracranial pressure is present, the brain stem can become trapped, which can cause brain damage.
It can also be light Bleeding or bruises Come to the area where the lumbar puncture was performed.
Another risk that is avoided in most cases by careful work under sterile conditions is infection of the spinal canal with germs. Since this can also play a role in wound healing, it should be ensured that the wound is well covered by the sterile dressing.
It is important that after a lumbar puncture one observes one's own body carefully with regard to any Signs of inflammation (Pain, fever) and with such complaints the doctor consulted.
The lumbar puncture itself can be painful due to the piercing of the different layers, because not all layers can be reached with the local anesthetic.
However, the lumbar puncture can also proceed with little pain in some patients. If the worries and fears before the procedure are too great, a medication can be administered in consultation with the doctor so that fears and pain are contained.
Read more on the topic Pain after a puncture.