Background Information:

What are the other Names for the Procedure?

• LP (Lumbar Puncture)
• Spinal Tap

What is Lumbar Puncture radiology procedure? (General Explanation)

• A Lumbar Puncture (LP) is a minimally-invasive procedure that is performed to collect a sample of the cerebrospinal fluid, to diagnose various medical conditions
• The cerebrospinal fluid (CSF) is a clear, colorless liquid that surrounds the brain and spinal cord and works as a protective cushion

What part of the Body does the Procedure involve?

The lower back (lumbar region) of the individual is involved during a Lumbar Puncture procedure.

Why is the Lumbar Puncture radiology procedure Performed?

A Lumbar Puncture is performed to help diagnose various medical conditions and infections (bacterial, viral, and fungal) as follows:

• Meningitis: An inflammation of the protective layer (meninges) surrounding the brain, caused by a virus, bacteria, or fungus
• Encephalitis
• Syphilis
• Guillain-Barre syndrome
• Multiple sclerosis
• Cancers of the brain and spinal cord
• Subarachnoid hemorrhage (bleeding around the brain)

The procedure is also used to measure the pressure of cerebrospinal fluid in the spinal canal.

What is the Equipment used? (Description of Equipment)

The equipment used for a Lumbar Puncture is the following:

• A thin, hollow needle is used to puncture the skin in the back, to access the epidural space
• Imaging guidance may be used to guide the needle into a proper space
• A fluoroscopy is usually used for these purposes. It provides a continuous real-time image to help guide the needle

What are the Recent Advances in the Procedure?

There have been no recent advances in the field of Lumbar Puncture procedure.

What is the Cost of performing the Lumbar Puncture radiology procedure?

The cost of Lumbar puncture procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Lumbar Puncture procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.mayoclinic.org/tests-procedures/lumbar-puncture/basics/definition/prc-20012679 (accessed on 10/20/2014)

http://kidshealth.org/parent/general/sick/lumbar_puncture.html (accessed on 10/20/2014)

http://www.dovemed.com/cerebrospinal-fluid-analysis/ (accessed on 10/20/2014)

Prior to Lumbar Puncture radiology procedure:

How does the Lumbar Puncture radiology procedure work?

• The cerebrospinal fluid is collected using Lumbar Puncture and the fluid sent to a laboratory for further analysis
• Laboratory analysis provides information about different types of cells in the fluid and their quantity, as well as glucose and protein content, which helps identify the cause of the disease or medical condition

How is the Lumbar Puncture radiology procedure Performed?

A Lumbar Puncture procedure is performed as follows:

• The individual sits on an examination table facing away from the physician, or lies down on the examination table, face down on their stomach
• The area of catheter insertion is shaved, sterilized with betadine solution and draped
• The lumbar region where the catheter is inserted is numbed using a local anesthetic
• Fluroscopy may be used to guide the needle in the spinal canal
• Once the needle is placed in the spinal canal, fluids starts coming out from the needle, which is then collected in test tubes already prepared
• After the desired quantity of fluid is removed, the needle is removed and pressure is applied to stop bleeding
• Patient may be asked to lie on their back after the procedure for an hour or two to keep pressure on the needle insertion site

Where is the Procedure Performed?

A Lumbar Puncture is performed as an inpatient or outpatient procedure at a hospital.

Who Performs the Procedure?

An interventional radiologist performs the Lumbar Puncture procedure.

How long will the Procedure take?

A Lumbar Puncture procedure takes about 30 minutes to perform.

Who interprets the Result?

The cerebrospinal fluid collected during a Lumbar Puncture is sent to a laboratory for further analysis. The results of the analysis are interpreted by an internal medicine physician or an infectious disease specialist.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Lumbar puncture:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
• Patient should notify physician if they are taking any kind of blood thinner medications such as warfarin (caumadin), heparin, aspirin, clopidogrel, pradaxa as it may increase risk of bleeding during the procedure
• Women should notify their physician if they are pregnant or may be pregnant
• Specific instructions may be given to the patient depending on the reason for lumbar puncture
• The individual may require to be driven home after the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for Lumbar Puncture procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent. 

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Lumbar Puncture procedure:

• Lumbar Puncture is a minimally invasive procedure that provides detailed information about CSF composition, which helps aid in any diagnosis
• No radiation remains in the individual’s body after the procedure

Following are the risks of the Lumbar Puncture procedure:

• Very rarely, brainstem herniation may occur following lumbar puncture due to increased intracranial pressure. To avoid this, a CT or MRI scan is performed prior to the procedure to determine if there is increased intracranial pressure
• A Lumbar Puncture may lead to bleeding in or around brain, such as in the epidural hematoma or subarachnoid hemorrhage
• Since skin is penetrated for access to the spinal canal during the procedure, there is a slight risk of infection

What are the Limitations of the Lumbar Puncture radiology procedure?

The Lumbar Puncture procedure is difficult to perform in individuals with the following conditions:

• Patients with spinal stenosis
• Those who are severely dehydrated
• Individuals with severe congenital disorders, such as kyphosis

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Lumbar Puncture procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Lumbar Puncture radiology procedure:

What is to be expected during the Lumbar Puncture radiology procedure?

The following may be expected during the Lumbar Puncture procedure:

• The individual may feel a pin-prick sensation, when the local anesthetic is injected into the desired area
• The needle or catheter insertion may cause slight pressure sensation, as it is being advanced into the spinal canal
• The patient shall be asked to remain very still throughout the procedure

What kind of Anesthesia is given, during the Procedure?

A local anesthetic is used to numb the area where the needle is inserted, during the Lumbar Puncture procedure.

How much Blood will you lose, during the Procedure?

The Lumbar Puncture procedure is a minimally invasive procedure and it involves a minimal loss of blood.

What are the possible Risks and Complications during the Lumbar Puncture radiology procedure?

The risks of Lumbar Puncture include the following:

• Very rarely, brainstem herniation may occur following the procedure due to increased intracranial pressure. To avoid this, a CT or MRI scan is performed prior to the procedure to determine, if there is increased intracranial pressure
• Lumbar Puncture may lead to bleeding in or around the brain, such as in the epidural hematoma or subarachnoid hemorrhage 

What Post-Operative Care is needed at the Healthcare Facility after the Lumbar Puncture radiology procedure?

• No specific post-operative care is needed at the healthcare facility after the procedure
• The patient should avoid bending or heavy lifting for a period of 2-3 days, after the procedure

After the Lumbar Puncture radiology procedure:

What is to be expected after the Lumbar Puncture radiology procedure?

• Patients are asked to lie down for few hours on their back after the procedure, in order to keep the pressure on needle insertion site and avoid leakage of the CSF
• Most patients do not have any medical issues after the procedure
• Though, some patients may develop headache, nausea, vomiting, and  dizziness lasting a few hours or longer, after the procedure
• Patient may feel some lower back tenderness or pain after the procedure
• Patient may take over-the-counter pain medications, such as acetaminophen, to relieve pain and headaches (under advice of the physician)

When do you need to call your Physician?

Do inform your physician if the following are observed after the Lumbar Puncture procedure:

• If you develop severe headache that is not relieved by over-the-counter medications
• Severe nausea and vomiting lasting several days
• Develop fever (over 101 degrees F) after a few days
• Develop redness or warmth at the needle insertion site accompanied by fever

What Post-Operative Care is needed at Home after the Lumbar Puncture radiology procedure?

No specific post-operative care is needed at home after the Lumbar Puncture procedure. 

How long does it normally take to fully recover, from the Procedure?

• Usually, the patients return to work within 24-48 hours of the procedure
• However, the patient should avoid bending or heavy lifting for a period of 2-3 days after the procedure
• Your physician will advise you on the safe time to return to your work

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue (CSF fluid) is taken for further examination and later disposed as per the standard medical procedure. 

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The CSF fluid removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the fluid is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Lumbar Puncture radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process
• A pathologist

The patient is advised to inquire and confirm the type of billing, before the Lumbar Puncture procedure is performed.