Lumbar Puncture

What is a lumbar puncture?

There is a small space that surrounds the nerves in your spine called the subarachnoid space. This space is filled with fluid. A lumbar puncture or “spinal tap” is an injection used to take fluid from this area. A lumbar puncture is always done on the part of the spine called the lumbar spine or the lower part of your back. Low-dose x-rays may be used to find the exact location for the injection.

During the injection you will need to lie on your stomach on an x-ray table. X-rays will be taken to help the doctor locate where the needle should enter the skin. This spot will be cleaned and marked. The doctor will inject local anesthesia to numb your skin. Then, a tube will be attached to the needle. The doctor will tilt the x-ray table to help the fluid flow into the tube. You will be in this position for 5-15 minutes.  The doctor will then gently remove the needle, put a Band-Aid® on the injection site and move the table back to a flat position.  You will be moved onto a stretcher and taken to a bed in the recovery area. You will need stay flat on your back for at least 2 hours.

Why do I need a lumbar puncture?

The fluid collected from your lumbar puncture may be used to:

  • follow up on results from blood tests or MRIs.
  • help your doctor find what is causing pain in your head or spine.

What do I need to do before the lumbar puncture?

Continue taking all your medications unless your health care team gives you different instructions. On the day of the injection, take any medications with small sips of water. You may need to stop taking blood thinners (Coumadin®, Heparin®, Lovenox®, Ticlid®, Plavix®). It is important to discuss this with your health care team before scheduling your lumbar puncture.

Note:

Drink a lot of fluids the day before the procedure. This may help increase the amount spinal fluid and make it easier and faster to do the procedure.

Tell your health care team if you:

  • have any problems with bleeding or clotting.
  • have had a tumor anywhere in your spine or brain.

What happens after the lumbar puncture?

You will stay in the recovery room and lay flat for at least 2 hours. Staying in a flat position gives the body time to heal so that spinal fluid does not leak from the injection site. If this happens, you will get a severe “spinal” headache. Spinal headaches get worse when you stand up and go away when you lay flat. It is best to lay flat as much as possible for 24 hours after a lumbar puncture.
Your health care team will monitor your progress in the recovery room and determine when it is safe for you to stand up and leave the hospital.

Note:

You cannot leave the hospital alone. You must have someone there to help you get home from the hospital.

What happens when I get home?

For the first 24 hours:

  • Lay flat as much as possible.
    You may get up to use the bathroom. It is best if you DO NOT sit up straight while you eat. You should recline or lean back while you eat.
  • DO NOT yell.
  • DO NOT cough.
    You should not have a lumbar puncture if you have a cold with a cough.
  • DO NOT strain (push hard) during bowel movements.
  • Drink a lot of fluids. It is important to replace the fluids that were removed from your body.

Keep the injection site clean and dry for at least 24 hours. There will be a bandage over the area where you had the injections. You can remove the bandage after 2-3 days if it does not fall off on its own. The site may be sore. You can use either ice-packs or heat -packs to help with the pain. You may also take Tylenol® or any NSAID (non-steroidal anti-inflammatory agent) such as Motrin®, Naprosyn®, Alleve®, Celebrex®, Vioxx® or Bextra®. Ask your health care team how much you can take and how often.

What if I my headache does not go away in 24 hours?

It may take more than 24 hours for the hole at the injection site to close completely. This means that small amounts of spinal fluid may still be leaking. Most spinal headaches go away with time. If your head does not hurt when you lay flat, try staying in this position for another 12-24 hours. If this is not possible, the headache still does not go away and/or the pain does not get better when you lay down, call your doctor right away. Your doctor may arrange for you to have a procedure called a “blood patch.”

To do a “blood patch” the doctor will take some blood from your arm and inject it into the place on your spine where you had the lumbar puncture. This blood then clots over the hole. This stops the fluid from leaking. You should feel better right away.

What are some side effects of a lumbar puncture?

There are some rare but serious side effects of a lumbar puncture.

  • You may have some bleeding in your spine during your epidural injection. This does not happen often. Your health care team will monitor the bleeding. The side effects from this bleeding may go away quickly.
    Very rarely, the side effects from the bleeding get worse. If this happens you may need surgery to stop the bleeding or to remove a blood clot.
  • It is possible for the spine to become infected. This is rare but serious. The infection would be treated with antibiotics. Tell your health care team right away if you have any pain, swelling, red skin or fever that lasts for 3 or more days after the injection.