When the doctor tells you, "I need to take some water from your spine and test it," you immediately feel a twinge of fear and trepidation, right? It's very common to think, "Oh, I'm going to get a needle stuck in your spine." Although many people are scared when they hear this name, this is actually not as scary or painful a test as we think. So let's learn more about it today.
Simply put, what is a lumbar puncture?
In Sinhala, we usually call this a "spinal tap." This is a special test that a doctor performs. This involves inserting a very fine, thin needle into your lower back, between two vertebrae, and taking a small sample of the clear, watery fluid that surrounds your brain and spinal cord.
This fluid is medically called cerebrospinal fluid (CSF) . This fluid is like a protective cushion for our brain and spinal cord. So, by examining a small sample of this fluid, we can find out a lot of important information about various medical conditions that affect your brain, nervous system, or spinal cord.
Why would a doctor recommend this test?
There are several reasons why a lumbar puncture may be performed. Sometimes it is used to diagnose a specific condition, and other times it is used to administer medication.
| Main reasons for testing | A simple description |
|---|---|
| For diagnosis | If there is a suspicion of a medical condition affecting the brain or spinal cord, this test is performed to confirm it. |
| Brain infection (Meningitis) | This is an essential test to check for bacterial or viral infections such as meningitis. |
| Swelling of brain tissue (Encephalitis) | Identify diseases that cause swelling of brain tissue. |
| Brain hemorrhages | Check for any bleeding in the brain. |
| Autoimmune diseases such as Multiple Sclerosis | Look for diseases in which the body's own immune system damages the nerves. |
| Cancer conditions | Check to see if cancer cells, such as leukemia, have entered the cerebrospinal fluid. |
| For treatment and other things | |
| To give painkillers | For anesthesia methods such as epidurals, which numb the lower part of the body during some surgeries. |
| To inject medicine | Some medications, such as anti-cancer drugs, are administered directly to the nervous system. |
| For special X-ray examinations | Inject a special dye before X-ray tests, such as a myelogram. |
| To reduce pressure inside the skull | If the fluid around the brain has increased and is causing pressure, remove some of it to reduce the pressure. |
Remember, not all of these reasons will apply to you. Your doctor will explain to you the reason for this test.
How should I prepare before this test?
Your doctor will usually give you instructions on what to do before the test. Some of the things that may be important include:
- CT scan or MRI scan: Sometimes, before a spinal tap, you may be asked to do this scan to see if there is increased pressure in the brain or spine.
- Blood test: This is important to see if your blood clotting ability is normal.
- Tell your doctor about any medications you are taking: If you are taking blood-thinning medications (such as Warfarin, Aspirin, Clopidogrel), you should definitely tell your doctor. You may be asked to stop taking these medications a few days before the test. Never stop taking them without your doctor's advice.
These preparations will help you perform the test safely and prevent unnecessary complications.
What happens during the test?
This is the part that many people are afraid of. So let's talk about it step by step.
1. Position: First, you will be made to lie down on a bed. Usually, you will be made to lie on your left side. Then, you will be asked to bend your knees and bring them close to your chest , as if you are curling up. Sometimes, you may be asked to sit in a chair and lean forward over a table. Although this position is a bit uncomfortable, it will increase the space between your vertebrae, making it easier to insert the needle. Therefore, it is very important to remain as still as possible.
2. Cleaning and numbing: Next, the doctor will thoroughly clean your lower back and inject a small amount of local anesthetic to numb it. You may feel a slight stinging sensation when the injection is given. However, the area will go completely numb after a while.
3. Inserting the needle: After numbing your back, the doctor will carefully insert a thin needle between two of your vertebrae (usually in the lower back). You will not feel any pain at this time, but you may feel some pressure.
4. Taking a water sample: Once the needle is in the right place, cerebrospinal fluid (CSF) will come out of it drop by drop. The doctor will collect the required amount of it into several small bottles. This will take a few minutes.
5. Removal and Bandage: After the sample is taken, the needle is carefully removed and a small bandage or plaster is applied to the needle insertion site.
The entire test usually takes between 15 and 30 minutes . The needle is in your back for only a few minutes.
Can you put me to sleep at this time?
No. You will not be given general anesthesia. You will only be given local anesthesia, so you will be fully conscious. But you will not feel any pain.
What should I do after the test?
After the examination, the doctor will give you a set of instructions. It is very important to follow them exactly.
- Lie down: You will be asked to lie down in bed for at least an hour, and possibly several hours, after the test. This will help prevent any headaches that may occur afterward.
- Drink plenty of water: Drink plenty of fluids, such as water and fruit drinks, throughout the day. This will help replenish the fluids lost from the body.
- Avoid activities: Avoid driving or operating heavy machinery for 24 hours. Also, avoid strenuous activities such as lifting weights or exercising for a day or two.
- Rest: Get as much rest as possible.
Is it normal to get a headache after a lumbar puncture?
Yes, this is the most common side effect that can occur after this test. Not everyone gets it, but about ten percent (10%) of people may experience this headache.
This is not like a normal headache. The headache gets worse when you sit or stand, and gets better when you lie down. It can start within a few hours or a few days after the test. This headache may also be accompanied by things like nausea, tachycardia, or hypotension.
These headaches usually go away on their own within a few days. Getting plenty of rest, drinking plenty of water, and drinking a beverage containing caffeine, such as coffee, can help. You can also ask your doctor about taking a painkiller like paracetamol.
What are the times when you should see a doctor?
There are usually no major problems after the test. However, if you experience any of the symptoms below, you should contact your doctor immediately .
| Symptoms to watch out for | Description |
|---|---|
| Very severe headache | A severe headache that lasts more than a few days and is not relieved by ordinary painkillers. |
| Something oozing from the puncture site | If blood or other fluid is leaking from the piercing site. |
| Signs of an infection | If the piercing site is red, swollen, feels hot, or you have a fever. |
| Numbness or weakness in the legs | If you feel an unusual tingling or numbness in your legs. |
Will this damage my spinal cord?
No. This is the biggest fear of many people. When performing a lumbar puncture, the needle is inserted much lower than the level of the spinal cord. Therefore, there is no chance of damage to the spinal cord. This is a very safe test.
Take-Home Message
- A lumbar puncture is nothing to be afraid of. It is a very important test to diagnose diseases related to the brain and nervous system.
- Your back will be numbed before the test, so you won't feel any pain, just some pressure.
- This test does not cause any damage to your spinal cord, because the needle is inserted much lower than it.
- You may experience a headache after the test. This can be managed by getting plenty of rest and drinking plenty of fluids.
- Follow the doctor's instructions exactly after the test. If you experience any unusual symptoms, inform the doctor immediately.
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