What’s a spinal tap?

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A spinal tap or lumbar puncture is most often a method of diagnosing the presence of certain diseases that involves removing some of the fluid around the spine and brainstem, via needle aspiration. This is called cerebrospinal fluid (CSF) and can be tested to determine many things about physical health. Alternatively, a puncture of this type can be used as an access method so that medicine, such as chemotherapy drugs, can be administered directly into the spinal and brainstem area; this is known as intrathecal therapy. Lumbar punctures have a previously deserved reputation for being painful, but improvements in medicine mean they are rarely as painful or challenging as they used to be, and their complications are far less common.

The general procedure for a spinal tap first usually involves doing a magnetic resonance imaging (MRI) or computed tomography (CT) scan to look for problems that contraindicate taking a tap. In particular, it is important that no large brain tumors are present, as CSF removal could cause fatalities if they are. Other patients who don’t usually have this test done include those with obvious skin infections in the area where the needle is injected, people with bleeding disorders, or those who are taking blood thinning medications.

If a patient has none of these risk factors, they may have a spinal tap. Patients are asked to assume a fetal position, with knees close to the chest. The area where the CSF will be aspirated, which is often between the fourth and fifth vertebrae, located in the lower back or lower back, is anesthetized with an anesthetic such as lidocaine. A needle is inserted into the spinal area and CSF is collected in several vials. The liquor can then be analyzed for various things, which could take a few days. Depending on the health of the patients, they may go home after lying down for a few hours after the test, or they may stay in the hospital.

One of the main reasons a spinal tap is done is to look for infections such as meningitis. Doctors may also evaluate cerebrospinal fluid for evidence of encephalitis, syphilis, brain tumors, bleeding in the brain, or conditions such as multiple sclerosis. CSF pressure measurements may also be taken during lumbar puncture. A lumbar puncture may also be performed to administer intrathecal therapy or to administer anesthesia.

The highest risk associated with modern spinal taps is spinal headaches. Headaches seem to occur more in children, and most headaches stop within a few days. Rarely, the headache lasts for several months. In very young children, there is still an increased risk of conditions such as paralysis from a tap, but this risk is lower than previously, and the benefits of tapping often significantly outweigh the risks. All taps carry a risk of infection and bleeding, but most people who haven’t been diagnosed with a serious illness resume activities soon after a tap is performed and experience no complications.

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