Conclusions
Though Lumbar puncture is widely performed, even at the level of primary
care providers, without frequent complications, however one should tread
cautiously while dealing patients with high risk of cerebral herniation
or severe coagulopathy.25 A Check List helps before LP
helps to improve confidence and avoids
complications34. With the increase in the number of
difficult LPs and intrathecal medications and sophisticated spinal
prosthesis, there is an increase in the demand for image-guided
LPs59. The intrathecal route is being increasingly
used for administering various medications, but the proper doses and
dosing schedules are still under research. There is convincing evidence
that an atraumatic needle tip results in lower rate of complications
and, therefore emphasizes the need to increase the awareness among
physicians to change the current practice.36Outpatient LP is as effective and safe as inpatient LP and can help
reduce the burden of admission and cost31. Newer CSF
biomarkers may pave the way for earlier diagnosis of neurodegenerative
diseases68. The practice of deferring LP until after
brain MRI probably may not be helpful in situations where performing LP
is vital.64 Certain clinical features should warrant
performing imaging before LP in suspected meningitis instead of
routinely performing imaging in every patient before
LP67.