Dr Gary Lau
In the following set of photos and videos, details of how a lumbar puncture is performed will be demonstrated. (Please note that medical students will not be expected to be perform lumbar punctures as part of their medical curriculum. These skills will be taught during Internship).
A lumbar puncture (LP, also known as a spinal tap) is a diagnostic and at times, therapeutic medical procedure. Diagnostic indications The main diagnostic indications of performing a LP is for collection and evaluation of cerebrospinal fluid (CSF) for diagnosis and exclusion of infectious, inflammatory and neoplastic diseases affecting the central nervous system. For example,…
A lumbar puncture (LP) is contraindicated in the following scenarios: Patients with bleeding diathesis, e.g. severe coagulopathy (INR >1.4) and thrombocytopenia (platelet <50 x 109/L). If coagulopathy or thrombocytopenia is not corrected prior to the procedure, spinal hematomas resulting in spinal cord compromise may result. Patients with increased intracranial pressure due to an intracranial lesion…
Patient Position A lumbar puncture (LP) can be performed with the patient in the lateral recumbent position or sitting upright. The lateral recumbent position is preferred because it allows accurate measurement of the opening pressure. The patient shown in the photo here is in the left lateral recumbent position. Positioning of the patient is crucial…
In the video shown here, the patient is in the left lateral recumbent position. The lumbosacral region of the patient is clearly exposed. The doctor has put on sterile gloves and is applying disinfectant over the lumbar region. Sterile draping is then applied as shown in the photo here.
By palpating onto the iliac crest and spinal processes of the back, the site of needle puncture for lumbar puncture (LP) is identified. As the spinal cord ends at the level of L2 in adults, the spinal needle can be inserted safely between the L3/4 or L4/5 levels. The highest point of the iliac crest…