Lumbar puncture

A lumbar puncture (Latin Lumbus - loin ) is a puncture of the dural sac in the lumbar spine. Here, a hollow needle is inserted into the Lumbalkanal at the level of the loin and cerebrospinal fluid taken from ( CSF). The lumbar puncture is the most common form of Liquorentnahme. The area of ​​injection is between the spinous processes of the second to fifth lumbar vertebra, which is significantly lower than the lower end of the spinal cord.

( Puncture of the cisterna cerebello - medullaris; well cistern puncture puncture between the occipital bone and the first cervical vertebra) Is a lumbar puncture - - such as tumors of the spine is not possible, cerebrospinal fluid, by a suboccipital puncture or ventricular puncture ( puncture of the cerebral ventricles ) are removed.

The first lumbar punctures were performed in 1891 by Heinrich Irenaeus Quincke in Kiel and in the same year by Walter Essex Wynter.

Diagnostic application

For inflammatory and malignant diseases of the meninges or the brain ( meningitis, encephalitis, neurosyphilis, multiple sclerosis, carcinomatous meningitis, and others) as well as in other diseases such important markers can be determined. Examples include the detection of bacteria, tumor cells, leukocytes (increases in inflammation / infection ), glucose ( decreased bacterial infections ), lactate, blood or free hemoglobin ( by bleeding ), the detection of disturbances of the blood -brain barrier (see Reiber scheme) and oligoclonal immunoglobulins ( for example, multiple sclerosis ). Depending on the problem, the samples are sent to the laboratory in the pathology and / or microbiology.

Already macroscopically can be read off some. A normal cerebrospinal fluid is water clear, inflammatory cerebrospinal fluid is more or less clouded strong, a red or red tinged cerebrospinal fluid can be observed in fresh real (for example, subarachnoid hemorrhage ) or artifizellen ( caused by the puncture itself) bleeding while possibly after earlier bleeding a yellowish discoloration can be seen.

Furthermore, a liquor pressure can occur. For this purpose, a sterile tube system is connected and read a ruler of the hydrostatic pressure in cmH2O ( centimeters of water ) to the puncture needle.

Therapeutic Application

Between the brain and the peripheral bloodstream, there is a barrier ( blood -brain barrier ), which is not permeable in a healthy person for some drugs. Therefore, be administered (such as chemotherapeutic agents ) through the spinal fluid in rare cases drugs. This effect due to the Liquorflussrichtung especially in the area of the spinal cord.

A spinal tap can also be used for short-term relief at elevated CSF pressure, for example in hydrocephalus after subarachnoid hemorrhage malresorptivus.

Modified application in anesthesia

Spinal anesthesia or spinal anesthesia is a form of regional anesthesia in which a spinal needle is inserted through a puncture of the subarachnoid space by means of a guide cannula and can be injected via these local anesthetics. For a temporary, reversible inhibition function of selected nerve segments is effected. It leads ( in that order ) for sympathectomy freedom from pain, numbness and inhibition of active mobility in parts of the body. As a method of anesthesia they will such as in cesarean sections or hip operations used in operations on the lower body, replacing a general anesthetic.

Contraindications and complications

Patients who are suspected of having an increase in intracranial pressure must not be punctured. Even in patients with a bleeding disorder ( for example, due to intake of drugs that inhibit blood clotting ) is contraindicated lumbar puncture. The operation of the puncture itself is usually only slightly painful. On a local anesthetic is therefore often omitted. The most common adverse side effect of lumbar puncture is the post- punk tional Headache occurs less frequently atraumatic puncture needles are used. It occurs in about 3-10 % of patients. It is characteristic of him that it decreases in supine position. Prophylactic bed rest is not effective. The post- punk tional Headache disappears within some days off by itself. Often temporary pain over the puncture site and radiating pain in the buttocks and hip occur. Schwererwiegende complications such as infection and bleeding are extremely rare. In some cases, the duration of post -lumbar puncture headache persist even up to 3-4 weeks. In addition, nausea and dizziness may be accompanying aftermath.