SPINAL PUNCTURE

From Big Medical Encyclopedia

SPINAL PUNCTURE (punctio cerebrospinalis; synonym: lumbar puncture, lumbar puncture, lumbar puncture) — introduction of a needle to the spinal channel with the diagnostic or medical purpose. Villages of the item use also at spinal anesthesia (see. Anesthesia local ).

For the first time S. the item were made independently from each other by G. Quincke and Wynter in 1891. In Russia at the end of 19 century S. the item and a research of cerebrospinal liquid (see) at various diseases of a nervous system were widely applied by G. I. Rossolimo, L. M. Pussep, etc.

In the diagnostic purposes C. of the item make for tonometry of cerebrospinal liquid, liquorodynamic tests (see), extraction of cerebrospinal liquid for a research of its cellular, chemical composition, carrying out colloid and serological tests. It is carried out also for administration of gas in subarachnoid (subarachnoid) space and cerebral cavities at a pnevmotsisternografiya and a pneumoencephalography (see), and also radiopaque substances at miyelografiya (see).

With to lay down. the purpose C. of the item make for introduction to a subarachnoid space of various pharmaceuticals (antibiotics, antiseptic agents, etc.). It is applied to extraction of cerebrospinal liquid at subarachnoidal hemorrhages of various etiology, and also after neurosurgical operations (to control of pressure of cerebrospinal liquid, administration of medicines, etc.).

A contraindication to a spinal puncture are purulent processes in the area pozvonochnikag septic diseases without defeat of a nervous system, and also volume processes in a temporal share of a cerebral hemisphere, in a back cranial pole, especially if there are signs of occlusion a face-voroprovodyashchikh of ways. Extraction of cerebrospinal liquid in these cases is dangerous in connection with a possibility of infringement of a brain trunk in tentorial or in big occipital openings.

Pages of the item carry out in the conditions of a hospital with observance of all requirements asepsises (see). Apply special needles 9 — 12 cm long to a puncture, with a diameter of 0,5 — 1 mm, with the keen edge and well driven mandrin mown at an angle 45 ° (see. Neurosurgical tools ).

Pages of the item make in position of the patient sitting or lying (see fig. 14, 15 and 16 to St. Anesthesia local ). In a sitting position the puncture is done to a thicket at pnevmotsisterno-and a pneumoencephalography, and also at a miyelografiya. In other cases of S. of the item carry out in position of the patient lying.

The patient is stacked sideways on a rigid surface so that his back was most curved kzad, and the head is pressed to a breast. Legs bend in knees and lead to a stomach. Slightly higher than the line connecting ileal crests (linia biiliaca), passes edges through top of an acantha of L4, the interval between acanthas of L3 and L4, below — an interval between acanthas of L4 and L5 is located. Since the spinal cord comes to an end at the level of the upper edge of Ln, the puncture below this level does not threaten with its damage. Usually it will be seen off at the level between Lm and by LIV.

the Diagrammatic representation of a spinal puncture on a sagittal section of lumbar department of a backbone: the aspirating needle is entered into a subarachnoid space between acanthas III and IV lumbar vertebrae; 1 — a medullary cone; 2 — terminal thread; 3 — skin and hypodermic cellulose; 4 — a linking of acanthas; 5 — firm and web covers of a spinal cord; 6 — a subarachnoid space.

After the choice of the place of a puncture the surgery field is carefully disinfected, produce local anesthesia of 0,5% solution of novocaine (3 — 4 ml). The aspirating needle is entered strictly in the sagittal plane, slantwise from below up according to an insignificant inclination of acanthas of lumbar vertebrae on the middle of distance between them from top to bottom. Pierce the skin, hypodermic cellulose, sheaves connecting acanthas, a yellow linking, firm and web covers of a spinal cord (fig). Depth of a puncture to a subarachnoid space averages 6 — 7 cm, corpulent patients — have more, children have 3 — 5 cm. At a puncture of a firm cover of a spinal cord peculiar «fall» of a needle is felt. Mandrin is extracted, and from a gleam of a needle drops of cerebrospinal liquid appear. If it does not arrive, it is necessary, having convinced of correctness of the direction of a needle, to change its situation, to advance on several millimeters of a kpereda or kzada or to turn round its pivot-center, to take and again to insert mandrin. Emergence from a needle of pure blood can demonstrate damage of a vertebral veniplex. In such cases the needle is taken, and the puncture is done at other level.

After the correct introduction of a needle to the vertebral channel to the patient suggest to straighten legs, to unbend the head. Then measure pressure of cerebrospinal liquid (normal it makes 100 — 180 mm of a water column in position of the patient lying also 250 — 300 mm in a sitting position). For tonometry of cerebrospinal liquid various designs of spring and mercury manometers are offered. In practice manometers in the form of the glass tube bent at right angle having long vertical and short horizontal a knee were widely adopted. The last is connected by means of a rubber tube to a metal cannula, the free end a cut is inserted into a gleam of the aspirating needle entered into the spinal canal.

For a research gain 1 — — 2 ml of liquid, and if necessary its bigger quantity. In order to avoid the side reactions caused by sharp fluctuation of pressure of cerebrospinal liquid she is recommended to be let out from a needle slowly, without taking out completely mandrin. After a puncture of the patient shall lie during 1,5 — 2 hours on a stomach and 2 — 3 days to observe a bed rest.

After S. headaches, dizzinesses, pains in a backbone can sometimes be the item.

At nek-ry patients the phenomena of a meningism are noted, to-rye remain usually several days. In these cases appoint analgetics and sedatives.

A heavy complication of S. of the item at volume processes of a brain is infringement of a brain trunk in tentorial or in big occipital openings. Emergence of symptoms of infringement demands urgent actions up to ventriculopunctures (see) and installations of a long drainage of a side ventricle.



Bibliography: Arendt A. A., etc. Fundamentals of neurosurgery of children's age, M., 1968; Arseni K. and Simiones-k at M. Neurosurgical vertebrome-dullyarny pathology, the lane from Romanians., Bucharest, 1973; Zograbyan S. G. Diagnostic operations at diseases of a head and spinal cord, M., 1955, bibliogr.; And r of e r I. M. Neyrokhirurgiya, M., 1982; Polenov A. L. Women ranks I.O. and Sozon-Yar about sh e in and the p A. BB. Fundamentals of practical neurosurgery, L., 1954; The Guide to operative measures, under the editorship of N. I. Blinov, L., 1963; Ugryumov V. M., Baskin I. S. and And r and to about in L. V. Operational neurosurgery, L., 1959; Friedman A. P. Bases of a likvorologiya, L., 1971; Grote W. Neurochirurgie, Stuttgart, 1975; King O. J. a. G 1 a s s W. W. Spinal subarachnoid hemorrhage following lumbar puncture, Arch. Surg., v. 80, p. 574, 1960; M e r r e m G. Lehrbuch der Neurochirurgie, B., 1964.


A. F. Sokolov.

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