Diagnostic Lumbar Puncture

Your referring physician has requested that you have a diagnostic lumbar puncture. The following is a description of the procedure as well as the potential complications, so that you may provide informed consent prior to the procedure. 

A lumbar puncture (LP) is an invasive procedure with some uncommon risks. After local anesthesia, a needle will be placed using fluoroscopic (x-ray) guidance into the lumbar/lower spine into the fibrous sac that contains spinal fluid and lumbar nerve roots. Spinal fluid is removed for laboratory tests, and the fluid pressure may be measured. You will typically be discharged immediately after the procedure or within one hour. Most complications of lumbar punctures are rare (except for spinal headache), and the procedure is very safe. You need to know the potential complications which include: 

1. BLEEDING. As with all needle procedures, bleeding can occur. As long as you have no bleeding tendency and are not on any blood thinners such as Coumadin or Plavix, bleeding complications are extremely rare. Rarely, patients have had to undergo emergency surgery to relieve pressure on the nerve roots and spinal cord because of bleeding after spinal needle procedures like lumbar punctures. 
2. INFECTION. Any needle passing through the skin can introduce infection, so there is a rare risk of infection such as meningitis. Meningitis is an extremely rare complication, and sterile technique will be used during the procedure to minimize this risk.
3. SPINAL HEADACHE. Spinal headache is the most common complication, and occurs if the small hole in the fibrous sac does not completely close after the needle puncture. The spinal fluid can then leak out, and if significant, the brain loses the cushioning effect of the spinal fluid which causes a severe headache when you sit or stand. Spinal headaches have been reported in up to 30-40% of patients after a lumbar puncture. Typically they occur about 1-2 days after the procedure.  These headaches are usually very positional, meaning they start when you sit or stand and go away when you lie down. It is important that you follow instructions to stay on bedrest only getting up to go to the bathroom for 24 hours after your lumbar puncture, and to drink plenty of fluids. The bed rest is important to allow the small hole in the sac to heal and close. If you develop a spinal headache, it is OK to treat yourself. As long as you do not feel ill, do not have a fever, and the headache goes away when you lie down, you may treat yourself with another day of bed rest with bathroom privileges and drinking plenty of fluids. Caffeine often helps with these headaches as well, if your doctor normally allows you to have caffeine. These simple actions almost always work. If not, please contact the radiologist who performed the procedure.  Uncommonly a procedure called an epidural blood patch may be performed in the hospital with a very high success rate in treating spinal headaches that don’t resolve with bedrest. This procedure is only done in about 1% or less of patients after a lumbar puncture.
4. ALLERGIC REACTION: The use of any medication, including x-ray contrast, has the possibility of producing an allergic reaction.  Please inform your physician of all of your known medical allergies before the procedure. 

Please feel free to ask any questions you may have about the procedure prior to signing the consent form.