Name of the Procedure:

Spinal Puncture, Lumbar, Diagnostic with Fluoroscopic or CT Guidance

Common name(s): Lumbar puncture, spinal tap
Technical term: Diagnostic spinal puncture using fluoroscopy or computed tomography (CT) guidance

Summary

A spinal puncture, also known as a lumbar puncture, is a medical procedure where a needle is inserted into the lower part of your spine to collect cerebrospinal fluid (CSF) for diagnostic purposes. Fluoroscopic or CT guidance is used to enhance accuracy and safety.

Purpose

• Medical conditions addressed: Infections (e.g., meningitis), bleeding around the brain (subarachnoid hemorrhage), neurological disorders (e.g., multiple sclerosis), and cancers affecting the brain or spine.
• Goals: To diagnose or rule out these conditions by analyzing the CSF and to measure the pressure of the fluid.

Indications

• Unexplained and severe headaches
• Fevers with neurologic symptoms
• Consistent vomiting or nausea without a clear cause
• Seizures
• Suspected bleeding in or around the brain
• Symptoms indicating possible neurological diseases
• Known or suspected cancers involving the brain or spine

Preparation

• Fasting: Patients may need to fast for several hours before the procedure.
• Medication adjustments: Certain medications may need to be paused. Consult with your physician.
• Diagnostic tests: Routine blood tests to ensure normal bleeding and clotting functions.

Procedure Description

1. Positioning: The patient lies on their side or sits up.
2. Site Preparation: The lower back is cleaned and sterilized.
3. Imaging Guidance: Fluoroscopy or CT imaging helps in precisely locating the correct spot.
4. Needle Insertion: A local anesthetic is applied, and a needle is inserted into the lumbar spine.
5. CSF Collection: Cerebrospinal fluid is collected in sterile tubes.
6. Needle Removal and Dressing: The needle is removed, and a small bandage is placed.

Tools: Sterile needle, syringes, collection tubes, fluoroscopic or CT imaging equipment
Anesthesia: Local anesthetic for numbing the site

Duration

Approximately 30 minutes to 1 hour

Setting

Hospital or outpatient clinic with fluoroscopic or CT imaging capabilities

Personnel

• Radiologist or neurologist
• Nurses or medical assistants
• Radiologic technologist

Risks and Complications

Common risks: Headache, localized pain, or discomfort at the puncture site
Rare risks: Bleeding, infection, nerve damage, cerebral herniation

Benefits

• Accurate diagnosis of serious medical conditions
• Tailored treatment plans based on definitive diagnosis
• Rapid symptom relief in certain cases

Recovery

• Post-procedure: Lie flat for a few hours to prevent headaches.
• Pain management: Over-the-counter pain relievers
• Restrictions: Avoid strenuous activities for 24-48 hours
• Follow-up: Results typically discussed in a follow-up appointment

Alternatives

• MRI or CT scan for non-invasive imaging
• Blood tests for certain conditions
• Pros and cons: Non-invasive tests have fewer risks but may not provide definitive results like CSF analysis.

Patient Experience

• During the procedure: Minimal discomfort due to local anesthesia, slight pressure during needle insertion.
• After the procedure: Some patients may experience headaches or back pain; proper hydration and rest are advised to alleviate symptoms.
• Pain management: Over-the-counter painkillers and hydration are usually effective.

Taking these steps will help both the medical team and the patient ensure a smoother procedure and successful recovery.