Puncture Needle With Sharp Pointed Tip Ending

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Lumbar punctures, which puncture the dura, are used commonly diagnostically to:
1) Sample the CSF to test the CSF pressure or to perform lab tests on the fluid. When meningitis is a possibility, the fluid should be tested for cells, chemistry, bacteria and so on. In some neurological diseases, the analysis of CSF can be helpful.
2) Perform diagnostic imaging such as myelography. The radiologist injects contrast into the intrathecal space (the space where CSF flows) in order to image the spine or brain with CT, MRI or nuclear medicine imaging.

Lumbar punctures are also used in treatment. Fluids and/or medications can be infused into the intrathecal space. Spinal anesthesia is a fairly common therapeutic use of lumbar puncture.

In most cases, the puncture hole in the dura will seal over spontaneously. A percentage of lumbar dural punctures will persist for days and more rarely for months or years. The most common clinical manifestation of this is a positional headache that is worse when upright following the procedure as a result of loss of CSF volume by leakage through the hole. This is termed “Post Dural Puncture Headache”, abbreviated to PDPH. This is almost always recognized by physicians promptly. There are a number of factors that influence the risk of the dural puncture to persist:
• The skill, technique and experience of the physician performing the procedure
• The size of the LP needle
• The type of LP needle
• Patient factors such as gender, age, body habitus
• Inadvertent movement of the patient during the procedure                                        

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