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Lumbar Puncture: Indications, Challenges and Recent advances
  • Biswamohan Mishra,
  • Venugopalan Vishnu
Biswamohan Mishra
All India Institute of Medical Sciences
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Venugopalan Vishnu
All India Institute of Medical Sciences
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Abstract

Introduction The methodological, diagnostic and therapeutic aspects of lumbar puncture (LP) and CSF study have undergone many radical changes, since it was first done in 1890 by Quincke. Objectives To explore the current trends in LP practice and to suggest a safety checklist to avoid the common complications and pitfalls. To study recent advances in diagnostic and therapeutic aspects of LP and safety and efficacy of outpatient LP. We also intended to explore the common practices that are being followed peri-LP procedure, whether these are real diligences or myth only. Methods With the key words of lumbar puncture, spinal tap, and CSF examination, we searched google scholar, Embase, PubMed, Medline and Cochrane library for relevant articles, case reports, case series, consensus guidelines, expert opinions, meta- analysis, and systematic reviews. Search terms included combinations of the Medical Subject Headings “spinal puncture”, “meningitis”, “cerebrospinal fluid”, “injections, spinal”, “Trends”, “Check List”, “Outpatient”,” Complication”, “Meningeal Enhancement Post LP”, “CT prior to LP”, “Difficult LP” and “biomarkers/ cerebrospinal fluid”. Articles published between January 1990 to May 2020in English were considered and were categorised into case reports, case series, meta-analysis, systematic review. Results Common complications of lumbar puncture can be avoided if a step by step approach to rule out complications is followed, and a safety checklist is adhered to. Atraumatic LP needle better than conventional ones. Outpatient LP is safe and efficacious. Medications administered through intrathecal and intraventricular routes are ever increasing. Biomarkers in CSF will have substantial clinical implications in neurodegenerative diseases. MRI prior to LP does not cause significant meningeal enhancement and the practice of delaying LP for imaging in every case should not be encouraged. Conclusions LP has evolved from being primarily a tool to diagnose CSF infections, to diagnosing, and treating major CNS autoimmune, neuroinflammatory and neurodegenerative and congenital diseases.