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Lumbar Puncture (Spinal Tap)

By

Megan Freedman

What is a lumbar puncture (spinal tap)?

A lumbar puncture, also known as a spinal tap, is a procedure to remove a small amount of cerebrospinal fluid (CSF) from around the spinal cord. The CSF is tested for infections and other conditions of the brain and spinal cord. A lumbar puncture is also used to inject medications and to measure and relieve pressure around the brain and spinal cord.

CSF is a clear fluid that surrounds the brain and spinal cord. It acts like a cushion to protect the brain and spinal cord. Your provider will evaluate CSF test results to diagnose many types of brain and spinal cord conditions, including meningitis and multiple sclerosis. Lumbar puncture can also be used for the injection of medications into the spinal cord, including chemotherapy and spinal anesthesia.

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A lumbar puncture is only one method used to diagnose or treat a variety of diseases, disorders and conditions of the brain and spinal cord. Discuss all of your options with your provider to understand which options are right for you.

Why is a lumbar puncture (spinal tap) performed? 

Your provider may recommend a lumbar puncture to diagnose or treat many types of brain and spinal cord conditions. Conditions diagnosed using a lumbar puncture include:

  • Cancer of the brain or spinal cord

  • Encephalitis, inflammation and swelling of the brain due to a viral infection or other causes

  • Guillain-Barré syndrome, an autoimmune nerve disorder

  • Headaches that are not diagnosed by less invasive tests

  • Meningitis, infection or inflammation of the sac around the brain and spinal cord

  • Multiple sclerosis, a disease that affects the brain and spinal cord causing
    weakness, lack of coordination, balance difficulties, and other problems

  • Pressure or bleeding within the spinal column

  • Reye’s syndrome, an illness involving brain and liver damage that is linked to giving aspirin to children

  • Transverse myelitis, a neurological disorder causing inflammation of the spinal cord

A lumbar puncture is also used to:

  • Inject contrast to take an X-ray test including myelogram

  • Inject medications into the spinal cord including chemotherapy for cancer, spinal anesthesia for surgery, and muscle relaxants for severe muscle spasms

  • Measure or relieve pressure in the brain and spinal cord for conditions including hydrocephalus

Who performs a lumbar puncture (spinal tap)?

A doctor, nurse practitioner (NP), nurse anesthesiologist, or physician assistant (PA) performs a lumbar puncture. The following types of doctors perform lumbar puncture:

  • Neurologists specialize in caring for people with diseases and conditions of the brain and nervous system, including the spinal cord, nerves, muscles, and related blood vessels.

  • Emergency medicine doctors and pediatric emergency medicine doctors specialize in emergency care of people with serious and life-threatening illnesses and injuries. Pediatric emergency medicine doctors further specialize in caring for infants, children and adolescents.

  • Anesthesiologists specialize in relieving pain and providing total medical care for patients before, during and after surgery.

How is a lumbar puncture (spinal tap) performed?

Your lumbar puncture will be performed in a hospital or clinic. It generally includes these steps:

  1. You will remove your clothing and dress in a patient gown.

  2. You will lie on your side on the examination table with your knees pulled up to your chest. As an alternative, you may sit on the edge of an examination table with your head and arms draped over a table in front of you. These positions allow the best access to your spine.

  3. Your provider will clean a small area on your lower back and place sterile drapes on your back to help maintain a sterile procedure.

  4. Your provider will inject a small amount of numbing medication under the skin.

  5. When the skin is numb, your provider will insert a very thin needle into your spinal canal and allow about a tablespoon of cerebrospinal fluid (CSF) to drip out of the needle into test tubes for testing. You must remain very still during this process.

  6. Your provider may attach a syringe of medication to the needle in your back to inject medication.

  7. Your provider may attach a device to the needle to measure pressure around the brain and spinal cord.

  8. Your provider will remove the needle and clean and bandage the area.

  9. Your provider will send the CSF to the laboratory for testing.

  10. You will need to lie flat for about an hour to prevent a headache.

Will I feel pain?

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Your comfort and relaxation important to you and your care team. You may feel a pinch, discomfort or stinging when the area is numbed, and pressure during the lumbar puncture. 

Your provider will give you pain and sedative medications as needed so that you can stay comfortable. If you have a headache after your lumbar puncture or are uncomfortable in any way, tell a member of your care team.

How do I prepare for my lumbar puncture (spinal tap)?

You are an important member of your own healthcare team. The steps you take before your lumbar puncture (spinal tap) can improve your comfort and help obtain the most accurate test results or best treatment outcome.

There generally is no special preparation for a lumbar puncture, but you can get ready for a lumbar puncture by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Learning about the procedure and asking any questions you have

  • Taking or stopping medications exactly as directed.

Questions to ask your provider

Having a lumbar puncture can be stressful. It is common to forget some of your questions during an office visit. You may also think of other questions after your appointment. Contact your provider with concerns and questions before your procedure and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a lumbar puncture? Are there any other options for diagnosing or treating my condition?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the procedure? When can I expect to return to work and other activities?

  • What kind of assistance will I need at home? Will I need a ride home?

  • How should I take my medications?

  • How will you treat my pain?

  • When will I get the results of my test?

  • What other tests or procedures might I need?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my lumbar puncture (spinal tap)?

Knowing what to expect after a lumbar puncture can help you get back to your everyday life as soon as possible.

How will I feel after lumbar puncture?

You may have a headache for a day or two after the procedure. The best way to prevent and relieve this is by drinking lots of water after the procedure. You may also have mild soreness, tenderness or pain in your lower back after the procedure. 

Your provider will recommend pain medication you can take. Acetaminophen (Tylenol) is often a sufficient pain reliever. You should only take nonsteroidal anti-inflammatory drugs (NSAIDs) as directed by your provider. People with certain conditions should not take NSAIDs. 

When can I go home?

You will probably go home within a few hours after a lumbar puncture. Your provider may tell you to rest in bed for one to three hours after the procedure. This helps prevent headaches. You may also need to limit physical activities for 24 hours.

When should I call my doctor or provider?

You should keep your follow-up appointments after a lumbar puncture.  Contact your provider if you have any concerns between appointments. Call your provider right away if you have:

  • Bleeding

  • Fever (you should not have any fever after lumbar puncture)

  • Headache

  • Leakage of fluid or blood from the lumbar puncture site in the lower back

  • New or unexplained symptoms including numbness, tingling and dizziness

  • Pain that is not controlled by your pain medication, new pain, or increase in pain

  • Rash or skin irritation

  • Swelling, warmth or redness from the lumbar puncture site in the lower back

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 13, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Lumbar Puncture (LP). Johns Hopkins Medicine. http://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/lumbar_puncture_lp_92,P076....
  2. Lumbar Puncture (or Spinal Tap). Harvard Health Publications, Harvard Medical School. http://www.health.harvard.edu/diagnostic-tests/lumbar-puncture.htm.
  3. Lumbar Puncture (Spinal Tap). KidsHealth from Nemours. http://kidshealth.org/parent/general/sick/lumbar_puncture.html#.
  4. Lumbar Puncture. Cleveland Clinic. http://my.clevelandclinic.org/services/lumbar_puncture_spinal_tap/hic_lumbar_puncture.aspxyx.
  5. Meningitis and Encephalitis Fact Sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm.
  6. Neurological Diagnostic Tests and Procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm.
  7. Spinal Tap. TeensHealth from Nemours. http://kidshealth.org/teen/cancer_center/diagnostic_tests/spinal_tap.html.

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