Lumbar Puncture: Indications, Challenges and Recent Advances

Abstract

The methodological, diagnostic and therapeutic aspects of lumbar puncture and cerebrospinal fluid (CSF) study have advanced leaps and bounds since its conception in 1890 by Quincke. CSF study is commonly used to diagnose CSF infections, but technological advances have enabled it to be used to diagnose many autoimmune, neuroinflammatory diseases of the central nervous system. CSF biomarkers are an important tool in diagnosing some neurodegenerative diseases; recent improvements in detecting these biomarkers may aid in developing drugs for these chronic, progressive, disabling diseases. Patients with diseases like spinal muscular atrophy, who were only treated supportively for decades, can now benefit from intrathecal nusinersen. Lumbar puncture is generally a safe intervention, yet complications can occur, ranging from mild and self-limiting, e.g. low backache, to severe, e.g. cerebral and spinal coning. Meta-analyses, consensus guidelines and systematic reviews have shown that using an atraumatic needle tip results in fewer complications, and guidelines emphasize the need to increase awareness among physicians and change current practice. Demand for image-guided lumbar puncture has increased significantly since 2000. Deferring lumbar puncture until after brain magnetic resonance imaging may be detrimental in situations where performing lumbar puncture is vital. Certain clinical features should warrant advanced imaging before lumbar puncture in suspected meningitis, instead of routinely performing imaging in every patient before lumbar puncture.