​Lumbar puncture positioning

Some neurological diseases cannot be diagnosed directly through X-ray images, nor can conclusions be drawn through doctor's observations, so lumbar puncture is needed at this time. A lumbar puncture is a procedure in which a doctor punctures the patient's lumbar spine to obtain a reflection of the condition of the peripheral nerves. Although the failure rate of lumbar puncture is very low, it still requires attention. So where should the lumbar puncture be located?

1. Lumbar puncture is one of the commonly used examination methods in neurology clinical practice. It is of great value in the diagnosis and treatment of nervous system diseases, simple and easy to perform, and relatively safe. However, if the indications are not properly grasped, it may aggravate the original condition in mild cases and even endanger the safety of the patient in severe cases. To perform this procedure safely and effectively, the physician needs to understand the contraindications to lumbar puncture, the relevant anatomy, and methods to minimize the risk of complications. Although lumbar punctures are rarely dangerous, when they occur they can be serious and potentially life-threatening. Understanding the indications, contraindications and correct operating methods of lumbar puncture can minimize the risk of danger.

2. The operation method is that the patient lies on his side on the bed with his hands around his knees to make the lumbar spine kyphotic and the intervertebral space widen. After routine local disinfection and infiltration anesthesia, puncture is performed. Generally, there will be resistance after inserting 4 to 5 cm, and you will feel the resistance suddenly decrease. Then pull out the needle core and rotate the needle tail to see cerebrospinal fluid dripping out. Cerebrospinal fluid is released according to different purposes and specific circumstances. Then insert the needle core, pull out the puncture needle, fix it with a sterilized gauze piece, and lie flat without a pillow for 4 to 6 hours. Before lumbar puncture, it should be noted that puncture should not be performed when there is inflammation in the local skin, soft tissue, or bone; puncture should not be performed on patients with obvious increased intracranial pressure and signs of brain herniation; patients who are in critical condition and are in shock or on the verge of shock; patients with symptoms of spinal cord compression or in a critical state where the spinal cord function has completely disappeared should not be punctured. Prevent headache, brain herniation and infection after puncture.

(I) For diagnosis: 1. Collect cerebrospinal fluid for testing. 2. Measure brain pressure to understand the level of intracranial pressure. 3. Perform cerebrospinal fluid dynamics examination. 4. Perform spinal cord or pneumoencephalography. (II) For treatment: 1. Drainage of bloody cerebrospinal fluid. 2. Release cerebrospinal fluid and reduce intracranial pressure. 3. Intrathecal injection of drugs to treat inflammation or tumors.