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.