Spinal puncture: Difference between revisions

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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.<ref name="pmid17062865"/> Reinsertion of the stylet before needle removal decreases headache.<ref name="pmid17062865"/>
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.<ref name="pmid17062865"/> Reinsertion of the stylet before needle removal decreases headache.<ref name="pmid17062865"/>


===Measurement of CSF pressure===
The normal opening pressure is 6 to 18 cm of H<sub>2</sub>O or 0.4 to 1.3 cm Hg ([[mercury]] is 13.6 times more dense than [[water]]).<ref name="pmid17062865">{{cite journal| author=Straus SE, Thorpe KE, Holroyd-Leduc J| title=How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis? | journal=JAMA | year= 2006 | volume= 296 | issue= 16 | pages= 2012-22 | pmid=17062865
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17062865 | doi=10.1001/jama.296.16.2012 }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17335165 Review in: ACP J Club. 2007 Mar-Apr;146(2):42] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
To accurately measure the opening pressure of the cerebrospinal fluid:
To accurately measure the opening pressure of the cerebrospinal fluid:
* The patient should be laying (not sitting)<ref>Becht FC (1920) [http://ajplegacy.physiology.org/cgi/content/citation/51/1/1 Studies on the cerebrospinal fluid]. Am J Physio 1920;51(1):1-125**</ref><ref>Loman J, Myerson A, Goldman D. Effects of alterations in posture on the cerebrospinal fluid pressure. Arch Neurol Psych. 1934:1279-1295.**</ref><ref name="pmid1271089">{{cite journal| author=Magnaes B| title=Body position and cerebrospinal fluid pressure. Part 1: clinical studies on the effect of rapid postural changes. | journal=J Neurosurg | year= 1976 | volume= 44 | issue= 6 | pages= 687-97 | pmid=1271089  
* The patient should be laying (not sitting)<ref>Becht FC (1920) [http://ajplegacy.physiology.org/cgi/content/citation/51/1/1 Studies on the cerebrospinal fluid]. Am J Physio 1920;51(1):1-125**</ref><ref>Loman J, Myerson A, Goldman D. Effects of alterations in posture on the cerebrospinal fluid pressure. Arch Neurol Psych. 1934:1279-1295.**</ref> Sitting may increase the pressure by 40 cm H<sub>2</sub>O.<ref name="pmid1271089">{{cite journal| author=Magnaes B| title=Body position and cerebrospinal fluid pressure. Part 1: clinical studies on the effect of rapid postural changes. | journal=J Neurosurg | year= 1976 | volume= 44 | issue= 6 | pages= 687-97 | pmid=1271089
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1271089 | doi=10.3171/jns.1976.44.6.0687 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/-->**</ref><ref name="pmid1271090">{{cite journal| author=Magnaes B| title=Body position and cerebrospinal fluid pressure. Part 2: clinical studies on orthostatic pressure and the hydrostatic indifferent point. | journal=J Neurosurg | year= 1976 | volume= 44 | issue= 6 | pages= 698-705 | pmid=1271090  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1271089 | doi=10.3171/jns.1976.44.6.0687 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/-->**</ref> In the sitting position, CSF pressure ranges from 32 to 63 cm H<sub>2</sub>O with a mean of 49 cm H<sub>2</sub>O.<ref name="pmid1271090">{{cite journal| author=Magnaes B| title=Body position and cerebrospinal fluid pressure. Part 2: clinical studies on orthostatic pressure and the hydrostatic indifferent point. | journal=J Neurosurg | year= 1976 | volume= 44 | issue= 6 | pages= 698-705 | pmid=1271090
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1271090 | doi=10.3171/jns.1976.44.6.0698 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1271090 | doi=10.3171/jns.1976.44.6.0698 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
* The patient's neck should be relaxed to prevent Queckenstedt's test which can raise pressure by 10-20 cm<ref name="pmid5005427">{{cite journal| author=Deliyannakis E| title=Influence of the position of the head on the cerebrospinal fluid pressure. Variations of the Queckenstedt sign. | journal=Mil Med | year= 1971 | volume= 136 | issue= 4 | pages= 370-2 | pmid=5005427  
* The patient's neck should be relaxed as flexing the neck can raise pressure by 12 cm H<sub>2</sub>O.<ref name="pmid9659014">{{cite journal| author=Dinsmore J, Bacon RC, Hollway TE| title=The effect of increasing degrees of spinal flexion on cerebrospinal fluid pressure. | journal=Anaesthesia | year= 1998 | volume= 53 | issue= 5 | pages= 431-4 | pmid=9659014
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=5005427 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/-->**</ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9659014 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid5005427">{{cite journal| author=Deliyannakis E| title=Influence of the position of the head on the cerebrospinal fluid pressure. Variations of the Queckenstedt sign. | journal=Mil Med | year= 1971 | volume= 136 | issue= 4 | pages= 370-2 | pmid=5005427
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=5005427 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/-->**</ref> This may be due to the patient inadvertently performing [[Queckenstedt's maneuver]] or similar.
* The position of the lower extremities does not matter.<ref name="pmid11136140">{{cite journal| author=Abbrescia KL, Brabson TA, Dalsey WC, Kelly JJ, Kaplan JL, Young TM et al.| title=The effect of lower-extremity position on cerebrospinal fluid pressures. | journal=Acad Emerg Med | year= 2001 | volume= 8 | issue= 1 | pages= 8-12 | pmid=11136140
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11136140 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>


==References==
==References==
<references/>
<references/>

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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 flexing the neck can raise pressure by 12 cm H2O.[9][10] This may be due to the patient inadvertently performing Queckenstedt's maneuver or similar.
  • The position of the lower extremities does not matter.[11]

References

  1. ↑ Anonymous (2024), 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. Research Blogging. Cite error: Invalid <ref> tag; name "pmid17062865" defined multiple times with different content
  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. Research Blogging.
  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. Research Blogging. **
  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. Research Blogging.
  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. ↑ 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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