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Lumbar Puncture, Myelogram, and CSF Leaks
Brandt C. Wible, MD; Ross Holwerda, MD; Coleman O. Martin, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        TERMINOLOGY

        • Synonyms

          • Spinal tap
        • Definitions

          • Lumbar puncture (LP): Insertion of spinal needle into thecal sac for diagnostic retrieval of CSF &/or injection of therapeutic or other diagnostic material
          • Myelogram: LP with injection of myelography-safe iodinated contrast into thecal sac to visualize spinal canal, spinal cord, & nerve roots
          • Epidural blood patch: Autologous blood injection into epidural space to treat spinal leak from prior dural puncture

        PREPROCEDURE

        • Indications

          • Contraindications

            • Preprocedure Imaging

              • Getting Started

                PROCEDURE

                • Patient Position/Location

                  • Equipment Preparation

                    • Procedure Steps

                      • Findings and Reporting

                        POST PROCEDURE

                        • Things to Do

                          • Things to Avoid

                            OUTCOMES

                            • Problems

                              • Complications

                                • Expected Outcomes

                                  Selected References

                                  1. American College of Radiology: ACR–ASNR–SPR practice parameter for the performance of myelography and cisternography. Updated 2019. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/myelog-cisternog.pdf
                                  2. Özütemiz C et al: Lumbar puncture under fluoroscopy guidance: a technical review for radiologists. Diagn Interv Radiol. 25(2):144-56, 2019
                                  3. Ning S et al: Safety of lumbar punctures in patients with thrombocytopenia. Vox Sang. 110(4):393-400, 2016
                                  4. Cauley KA: Fluoroscopically guided lumbar puncture. AJR Am J Roentgenol. 205(4):W442-50, 2015
                                  5. Migdal VL et al: Risk-benefit analysis of lumbar puncture to evaluate for nontraumatic subarachnoid hemorrhage in adult ED patients. Am J Emerg Med. 33(11):1597-601, 2015
                                  6. Abel AS et al: Effect of patient positioning on cerebrospinal fluid opening pressure. J Neuroophthalmol. 34(3):218-22, 2014
                                  7. Schwartz KM et al: Position-related variability of CSF opening pressure measurements. AJNR Am J Neuroradiol. 34(4):904-7, 2013
                                  8. Harreld JH et al: Myelography: a primer. Curr Probl Diagn Radiol. 40(4):149-57, 2011
                                  9. Layton KF et al: Recommendations for anticoagulated patients undergoing image-guided spinal procedures. AJNR Am J Neuroradiol. 27(3):468-70, 2006
                                  10. Sandow BA et al: Myelography complications and current practice patterns. AJR Am J Roentgenol. 185(3):768-71, 2005
                                  11. Safa-Tisseront V et al: Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 95(2):334-9, 2001
                                  12. Bøhn HP et al: Inadvertent intrathecal use of ionic contrast media for myelography. AJNR Am J Neuroradiol. 13(6):1515-9, 1992
                                  Related Anatomy
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Preprocedure

                                      • Procedure

                                        TERMINOLOGY

                                        • Synonyms

                                          • Spinal tap
                                        • Definitions

                                          • Lumbar puncture (LP): Insertion of spinal needle into thecal sac for diagnostic retrieval of CSF &/or injection of therapeutic or other diagnostic material
                                          • Myelogram: LP with injection of myelography-safe iodinated contrast into thecal sac to visualize spinal canal, spinal cord, & nerve roots
                                          • Epidural blood patch: Autologous blood injection into epidural space to treat spinal leak from prior dural puncture

                                        PREPROCEDURE

                                        • Indications

                                          • Contraindications

                                            • Preprocedure Imaging

                                              • Getting Started

                                                PROCEDURE

                                                • Patient Position/Location

                                                  • Equipment Preparation

                                                    • Procedure Steps

                                                      • Findings and Reporting

                                                        POST PROCEDURE

                                                        • Things to Do

                                                          • Things to Avoid

                                                            OUTCOMES

                                                            • Problems

                                                              • Complications

                                                                • Expected Outcomes

                                                                  Selected References

                                                                  1. American College of Radiology: ACR–ASNR–SPR practice parameter for the performance of myelography and cisternography. Updated 2019. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/myelog-cisternog.pdf
                                                                  2. Özütemiz C et al: Lumbar puncture under fluoroscopy guidance: a technical review for radiologists. Diagn Interv Radiol. 25(2):144-56, 2019
                                                                  3. Ning S et al: Safety of lumbar punctures in patients with thrombocytopenia. Vox Sang. 110(4):393-400, 2016
                                                                  4. Cauley KA: Fluoroscopically guided lumbar puncture. AJR Am J Roentgenol. 205(4):W442-50, 2015
                                                                  5. Migdal VL et al: Risk-benefit analysis of lumbar puncture to evaluate for nontraumatic subarachnoid hemorrhage in adult ED patients. Am J Emerg Med. 33(11):1597-601, 2015
                                                                  6. Abel AS et al: Effect of patient positioning on cerebrospinal fluid opening pressure. J Neuroophthalmol. 34(3):218-22, 2014
                                                                  7. Schwartz KM et al: Position-related variability of CSF opening pressure measurements. AJNR Am J Neuroradiol. 34(4):904-7, 2013
                                                                  8. Harreld JH et al: Myelography: a primer. Curr Probl Diagn Radiol. 40(4):149-57, 2011
                                                                  9. Layton KF et al: Recommendations for anticoagulated patients undergoing image-guided spinal procedures. AJNR Am J Neuroradiol. 27(3):468-70, 2006
                                                                  10. Sandow BA et al: Myelography complications and current practice patterns. AJR Am J Roentgenol. 185(3):768-71, 2005
                                                                  11. Safa-Tisseront V et al: Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 95(2):334-9, 2001
                                                                  12. Bøhn HP et al: Inadvertent intrathecal use of ionic contrast media for myelography. AJNR Am J Neuroradiol. 13(6):1515-9, 1992