Note: the information below is a general guide only. The arrangements, and the way tests are performed, may vary between different hospitals. Always follow the instructions given by your doctor or local hospital.
What is a lumbar puncture?
A lumbar puncture (sometimes called a spinal tap) is a procedure where a sample of cerebrospinal fluid (CSF) is taken for testing. CSF is the fluid that surrounds the brain (cerebrum) and spinal cord. This test is mainly used to diagnose meningitis (an infection of the meninges - the structure that surrounds the brain and spinal cord). It is also used to help diagnose some other conditions of the brain and spinal cord.
How is a lumbar puncture done?
In most cases, a lumbar puncture is done as an emergency procedure to diagnose meningitis quickly. In some cases it is done as an outpatient for other reasons.
Usually, you lie on a couch on your side with your knees pulled up against your chest. Sometimes it is done with you sitting up and leaning forwards on some pillows. The doctor will clean an area of your lower back with antiseptic. They will then inject some local anaesthetic into a small area of skin which lies over a space between two lower spinal bones (vertebrae). This stings a little at first but then makes the skin numb.
The doctor then pushes a needle through the skin and tissues between two vertebrae into the space around the spinal cord which is filled with CSF. Because the skin is numbed with local anaesthetic, most people do not feel pain. You may feel pressure as the needle is pushed in. However, some people do have a sharp feeling in the back or leg when the needle is pushed through.
By Blausen.com staff, "Blausen gallery 2014", Wikiversity Journal of Medicine, via Wikimedia Commons
Some fluid leaks back through the needle and is collected in a sterile pot. If you have possible meningitis, this fluid sample is sent to the laboratory to be examined under the microscope to look for germs (bacteria). It is also 'cultured' to see if any bacteria grow and what type they are. The fluid can also be tested for protein, sugar and other chemicals if necessary. Sometimes the doctor will also measure the pressure of the fluid. This is done by attaching a special tube to the needle, which can measure the pressure of the fluid coming out.
The needle is usually in for about 1-2 minutes. As soon as the required amount of fluid is collected, the needle is taken out and a sticking plaster put over the site of needle entry.
Are there any side-effects or risks from a lumbar puncture?
Some people develop a headache after the test. This usually goes after a few hours. It is best to lie down for a few hours after the test, as this makes a headache less likely to develop. Other problems are rare - for example, infection or bleeding of the site of the needle entry. Any damage to the spinal cord or brain as a result of lumbar puncture is rare.
Further reading and references
Bacterial meningitis and meningococcal septicaemia: Management of bacterial meningitis and meningococcal septicaemia in children and young people younger than 16 years in primary and secondary care; NICE Clinical Guideline (last updated February 2015)
Meningococcal disease: guidance, data and analysis; Public Health England, February 2017
Brouwer MC, McIntyre P, Prasad K, et al; Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015 Sep 12(9):CD004405. doi: 10.1002/14651858.CD004405.pub5.
Viallon A, Botelho-Nevers E, Zeni F; Clinical decision rules for acute bacterial meningitis: current insights. Open Access Emerg Med. 2016 Apr 198:7-16. doi: 10.2147/OAEM.S69975. eCollection 2016.
Sepsis - recognition, diagnosis and early management; NICE Guideline (July 2016)
Immunisation against infectious disease - the Green Book (latest edition); Public Health England
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