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A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF ) surrounding the brain and spinal cord.
During a lumbar puncture, a needle is carefully inserted into the spinal canal low in the back (lumbar area). Samples of CSF are collected. The samples are studied for color, blood cell counts, protein, glucose, and other substances. Some of the sample may be put into a container with a growth substance. This is called a culture. If any bacteria or fungi grow in the culture, an infection may be present. The pressure of the CSF also is measured during the procedure.
A lumbar puncture is done to:
A lumbar puncture may also be done to:
In rare cases, a lumbar puncture may be used to lower the pressure in the brain caused by too much CSF.
Before you have a lumbar puncture, tell your doctor if you:
You will empty your bladder before the procedure.
You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.
Talk to your doctor about any concerns you have regarding the need for the procedure, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form( What is a PDF document? ).
A lumbar puncture may be done in your doctor's office, in an emergency room, or at your bedside in the hospital. It may also be done in the radiology department if fluoroscopy is used.
You will lie on a bed
on your side with your knees drawn up toward your chest. Or you may sit on the edge of a chair or bed and lean forward over a table with your head and chest bent toward your knees. These positions help widen the spaces between the bones of the lower spine so that the needle can be inserted more easily. If fluoroscopy is used, you will lie on your stomach so the fluoroscopy machine can take pictures of your spine during the procedure.
Your doctor marks your lower back (lumbar area) with a pen where the puncture will occur. The area is cleaned with a special soap and draped with sterile towels. A numbing medicine (local anesthetic) is put in the skin.
Then a long, thin needle is put in the spinal canal. When the needle is in place, the solid central core of the needle (stylet) is removed. If the needle is in the right spot in the spinal canal, a small amount of cerebrospinal fluid (CSF) will drip from the end of the needle. If not, the stylet will be put back in and the needle will be moved in a little farther or at a different angle to get to the fluid. Your doctor may need to move to another area of your spine if it is hard to get to the spinal fluid.
When the needle is in the spinal canal, a device called a manometer is hooked to the needle to measure the pressure of the CSF. You may be asked to straighten your legs while you are lying down. Your doctor takes the pressure reading, called the opening pressure, and checks whether the fluid is clear, cloudy, or bloody. Several small samples of fluid are collected and sent to the lab for study.
A final pressure reading, called the closing pressure, may be taken after the fluid samples are done. The needle is taken out and the puncture site is cleaned and bandaged.
The doctor also may look into your eyes using a special lighted scope (ophthalmoscope) to see if the pressure is high.
The entire procedure takes about 30 minutes.
To lower your chance of getting a headache following a lumbar puncture, you may be told to lie flat in bed or with your head slightly raised for 1 to 4 hours. Since your brain makes new CSF all the time and replaces it 2 or 3 times a day, the small amount of fluid that is removed will be quickly replaced. You may be told to drink extra fluids after the procedure to help prevent or to reduce the severity of a headache.
Some people find it uncomfortable to lie curled up on their side. The soap may feel cold on your back. You will probably feel a brief pinch or sting when the numbing medicine is given. You may feel a brief pain when the spinal needle is inserted or repositioned.
During the procedure, the needle may touch one of your spinal nerves and cause a tingling feeling, like a light electrical shock, running down one of your legs.
You may feel tired and have a mild backache the day after the procedure. Some people have trouble sleeping for 1 to 2 days.
A lumbar puncture is generally a safe procedure. In some cases, a leak of cerebrospinal fluid (CSF) may develop after a lumbar puncture. Symptoms of this problem are a headache that does not go away after 1 to 2 days. A CSF leak can be treated with a blood "patch," in which the person's own blood is injected into the area where the leak is occurring in order to seal the leak.
Some people (10% to 25%) develop a headache after having a lumbar puncture. Of those who do get headaches, only about half report that they are severe. These headaches may last up to 48 hours and then go away on their own. Pain medicine does not help control the headache, but lying flat in bed for several hours after the procedure may help the headache.
About 1 out of 1,000 people who have a lumbar puncture have a minor nerve injury. This heals on its own with time. Serious nerve injury is very rare. There is also a small chance of infection of the CSF (meningitis), bleeding inside the spinal canal, or damage to the cartilage between the vertebrae. Your doctor will talk with you about these risks.
A lumbar puncture may cause serious problems for people who have high pressure in the brain caused by a tumor, a pocket of infection in the brain (abscess ), or major bleeding inside the brain. Your doctor will check your nervous system, spinal cord and brain before doing a lumbar puncture. In some cases, a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may be done before the lumbar puncture to know that it is safe to do the puncture.
Call your doctor immediately if you have:
A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid ( cerebrospinal fluid, or CSF ) surrounding the brain and spinal cord. Many different tests can be done on the CSF. Some results will be ready right away, some will take a few hours after the procedure, and others will take several weeks.
The normal values listed here—called a reference range—are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what's normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.
CSF is normally clear and colorless.
Normal CSF pressure in the lower back for an adult ranges from 90–180 millimeters (mm) water. For children younger than 8 years old, the normal opening pressure range is 80–100 mm water.
The normal protein content of CSF in an adult's lower back (lumbar) region is 15–45 milligrams per deciliter (mg/dL) or 150–450 milligrams per liter (mg/L) . Older adults and children may have higher values that are still in the normal range.
The normal range for CSF glucose content for adults is 40–70 mg/dL or 2.2–3.9 millimoles per liter (mmol/L) . For children, the normal range for glucose in CSF is 60–80 mg/dL or 3.3–4.4 mmol/L.
Normal CSF contains no red blood cells (RBCs) . The white blood cell (WBC) count for adults is 0–5 WBCs per cubic millimeter (mm 3). Children may normally have a higher WBC count. No neutrophils are present.
No infectious organisms (such as bacteria, fungi, or a virus) are found in the CSF sample. No tumor cells are present.
Blood in the CSF can result from bleeding (hemorrhage) in or around the spinal cord or brain, but it may also be caused by tiny blood vessel poked during the spinal tap. If a brain hemorrhage has occurred, the color of the CSF may change from red to yellow to brown over several days. Bleeding caused by the lumbar puncture itself will show more red blood cells in the first sample collected than in later samples. Cloudy CSF may mean an infection (such as meningitis or a brain abscess ) is present.
High CSF pressure may occur as a result of swelling (edema) or bleeding (hemorrhage) in the brain, infection (such as meningitis), stroke , or other circulatory problems. Below-normal pressure may mean a blocked spinal canal.
A high level of protein may be caused by bleeding in the CSF, a tumor or spread of a cancer from another area of the body, diabetes , infection, injury, Guillain-Barré syndrome , severe hypothyroidism , or other nerve diseases. An increase in antibodies (immune system proteins) may be caused by inflammation in people who have multiple sclerosis , immune system disorders, or bacterial and viral infections.
Low glucose levels in the CSF are abnormal and may be caused by bacterial meningitis. Viral meningitis does not often cause low glucose levels in the CSF. Brain hemorrhage may also cause low glucose levels several days after bleeding begins. Higher-than-normal glucose levels are often caused by diabetes.
Red blood cells (RBCs) in the CSF can result from bleeding. High levels of white blood cells (WBCs) can indicate meningitis.
Bacteria or other organisms in the CSF means that an infection (such as syphilis ) or disease is present. Bacterial markers (bacterial antigens ) that show up mean meningitis. Cultures or stains of the CSF may also help show the cause of meningitis or encephalitis . Identifying tumor cells can show cancer is present.
Your doctor may order other special tests on the CSF fluid depending on your symptoms and past health.
Reasons you may not be able to have the procedure or why the results may not be helpful include:
Fischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health.
Other Works Consulted
Pagana KD, Pagana TJ (2014). Mosby's Manual of Diagnostic and Laboratory Tests, 5th ed. St. Louis: Mosby.
Current as ofJune 25, 2018
Author: Healthwise StaffMedical Review: E. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineMartin J. Gabica, MD - Family Medicine
Current as of:
June 25, 2018
E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine
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