Techniques, contraindications, and complications of CSF collection procedures

Abstract

Lumbar puncture (LP), also known as spinal tap, is the most frequently used technique through which the restricted compartment of the subarachnoid space is accessed to sample cerebrospinal fl uid. An LP can have both diagnostic and therapeutic indications. To perform an LP, the optimal length, size, and type of needle should be used, depending on the medical indication. Needles used for LP can differ in length, diameter, and design. Head-to-head studies are in favor of atraumatic-type and small-diameter needles given the lower incidence of postlumbar puncture headache (PLPH), and consensus-based guidelines recommend to use 25G atraumatic needles. The most important contraindication to perform an LP is a posterior fossa mass and intracranial hypertension, given the risk of central nervous system or tonsillar herniation. Other contraindications are local infections at the puncture site, congenital abnormalities, and uncorrected bleeding diathesis. The LP procedure is easy to perform by an experienced physician with proper understanding of the anatomical implications and results in low risks of complications. The most common complaint after an LP is PLPH; other infrequent complications include infections, local hematomas, pain, and local discomfort. In conclusion, an LP is a viable therapeutic technique and a common diagnostic procedure, which, if performed correctly, has a low complication rate and a high diagnostic yield and is usually more tolerable than patients expect.