How long is it normal to have back pain after lumbar puncture?

Lumbar puncture is a method for diagnosing central nervous system diseases. It is also often used to examine some encephalitis. After lumbar puncture, low back pain and numbness may occur. These are normal physiological phenomena. Because local blood circulation may deteriorate after surgery, you should pay attention to health care, exercise, do more massage, etc.

Indications for lumbar puncture

1. Diagnosis and differential diagnosis of inflammatory diseases of the central nervous system: including purulent meningitis, tuberculous meningitis, viral meningitis, fungal meningitis, Japanese encephalitis, etc.

2. Diagnosis and differential diagnosis of cerebrovascular accident: including cerebral hemorrhage, cerebral infarction, subarachnoid hemorrhage, etc.

3. Diagnosis and treatment of tumor diseases: used to diagnose meningeal leukemia and treat meningeal leukemia by intrathecal injection of chemotherapy drugs through lumbar puncture.

4. Measure the intracranial pressure and understand whether the subarachnoid space is blocked.

5. Intrathecal administration.

Prevention and treatment of complications

1. Intracranial hypotension syndrome: refers to the cerebrospinal fluid pressure in the lateral position below 0.58-0.78 kPa (60-80 mm water column), which is more common. It is mostly caused by the puncture needle being too thick, the puncture technique being unskilled or the patient getting up too early after the operation, which causes the cerebrospinal fluid to continuously flow out of the spinal meningeal puncture hole. The patient's headache is significantly aggravated after sitting up. Severe cases are accompanied by nausea, vomiting or dizziness, fainting, and the headache can be alleviated or relieved when lying flat or with the head lowered. A few patients may also experience impaired consciousness, mental symptoms, and meningeal irritation signs, which may last for one to several days. Therefore, fine needle puncture should be used. After the operation, the patient should lie flat without a pillow (preferably prone) for 4-6 hours and drink plenty of boiled water (avoid strong tea and sugary water). This can often prevent it. If it has already occurred, in addition to instructing the patient to continue lying flat and drinking plenty of boiled water, 10-15ml of distilled water or 500-1000ml of 5% grape saline solution can be injected intravenously as appropriate, 1-2 times/d, for several days, and it can often be cured. Lumbar puncture can also be performed again to inject 20-30 ml of normal saline into the spinal canal or outside the dura mater to eliminate the negative pressure in the epidural space and prevent further leakage of cerebrospinal fluid.

2. Brain herniation: When intracranial pressure increases (especially in the posterior cranial fossa and temporal space-occupying lesions), or when too much fluid is released too quickly during lumbar puncture, brain herniation may occur during the puncture or within a few hours after the operation, so strict attention and prevention should be paid. If necessary, before the order is placed, 20% mannitol solution (250 ml) or other dehydrating agents can be quickly injected intravenously, and then a fine needle puncture can be used to slowly drip out a few drops of cerebrospinal fluid for laboratory examination. If this unfortunately happens, appropriate rescue measures should be taken immediately, such as intravenous injection of 200-400ml of 20% mannitol and hypertonic diuretic dehydration agents, and if necessary, ventricular puncture to drain the fluid and rapid injection of 40-80ml of normal saline into the spinal canal, but it is generally difficult to be effective.

3. Sudden aggravation of existing spinal cord and spinal nerve root symptoms: This is more common in spinal cord compression, due to changes in pressure after lumbar puncture, which leads to changes in the pressure balance between the spinal cord, nerve roots, cerebrospinal fluid and lesions in the spinal canal. It can aggravate symptoms such as radicular pain, paraplegia, and urinary and bowel disorders. In high cervical spinal cord compression, respiratory distress and arrest may occur. If the above symptoms are not serious, 30-50ml of normal saline can be injected into the spinal canal first. If the therapeutic effect is not good, please ask the surgeon to consider surgical treatment as an emergency.

In addition, complications may include intracranial infection and nerve root damage in the cauda equina due to improper puncture, which are less common.