Spinal puncture, lumbar, diagnostic; with fluoroscopic or CT guidance
CPT4 code
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
- Positioning: The patient lies on their side or sits up.
- Site Preparation: The lower back is cleaned and sterilized.
- Imaging Guidance: Fluoroscopy or CT imaging helps in precisely locating the correct spot.
- Needle Insertion: A local anesthetic is applied, and a needle is inserted into the lumbar spine.
- CSF Collection: Cerebrospinal fluid is collected in sterile tubes.
- 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.