What to Expect During Your First Spinal Tap

First, it is crucial that the procedural area is sterile as to prevent bacteria from entering the spinal column.

You may be advised to lie on your stomach, curl up on your side, or in some cases instructed to sit at the edge of the bed hunched over like a shrimp.

The tending physician will place a sterile drape over your back and wipe down the lower back with antiseptic wipes thoroughly.

A local anesthetic may be injected in the lower back near the spine.

The anesthesiologist may feel around your lower spine to determine exactly where to administer the puncture. That area will be marked.

You will be advised to remain still and calm as they insert the needle.

Depending on which procedure you are having will determine what takes place next. In the case of a basic spinal tap, a gauge will be used to measure the opening pressure of spinal fluid. Samples may be collected to test for any abnormalities.

Once the procedure is over, the needle is removed, and a bandage is placed over the site.

You may be advised to continue lying flat as well as consume large amounts of fluids and caffeine. Following these instructions will help the puncture site heal over and prevent further complications.

Typically, you can resume normal activities within a day or so, provided there are no complications. Though it may be advised to take it easy at first till you know for sure all has healed.

Spinal fluid is measured via a spinal tap. You can picture this as a gauge measuring the pressure of a tire.

The average opening pressure ranges loosely between 10-20 cmH20 (centimeters of water), though some prefer the range of 6-25. You may also see the reading as mmHg (millimeters of mercury).

Anything higher than this would give evidence of Intracranial Hypertension. (Imagine overloading said tire with air). Anything lower would indicate Intracranial Hypotension.

It is important to note that this is an average. Your personal average of normal pressure may be naturally on the low end already to where you may feel more symptomatic without ever surpassing 25.

Spinal fluid is also always fluctuating throughout the day and night, so it may be possible that your tap may not catch what you are actually experiencing, especially if you are not symptomatic at the time.

While it is perfectly understandable to have anxiety about receiving your first spinal tap, one of the best things you could possibly do is try to relax. This one may be easier said than done, so here are a few tips from my personal experience:

I find it helps to keep myself distracted through medical procedures. This may mean singing a song that brings peace, quoting scripture in your mind, or daydreaming. You may even hold a conversation with the anesthesiologist to help keep your mind off of things.

Sometimes, it helps not to focus on the details of what is going on. Other times, you may feel like you want to know exactly what is happening so that you feel more prepared for it. In this case, you can ask your anesthesiologist to narrate the procedure as they go.

One thing that also helps me, especially if the procedure seems to be taking longer than expected, is to remind myself that there will be a time soon that all of this will be over. Before I know it, I will be back in the comforts of my own home and this will all be part of my past.

A spinal needle is most often inserted into the lower lumbar region of the back (typically between L3 & L4). The needle will pierce through several layers, beginning with the skin and ending in the subarachnoid space where your spinal fluid circulates.

The needle used for a spinal tap is typically around 3 ½ inches. However, only about 3-4 centimeters may enter through to your spinal column.

Most spinal taps tend to be performed while awake. In some cases, anesthesia or medication to help you relax may be given.

The pain response to a spinal tap depends solely on the individual and can vary greatly. You may feel a stinging as the initial anesthetic is administered. Once the anesthetic takes its effect, you may only feel pressure where the needle is inserted.

From my personal experience, it is very similar to dental work, where the mouth is numb, yet you feel pressure as they work on your tooth. I actually feel more peace receiving a spinal tap than I do an IV.

Unfortunately, not everyone has such a great experience.

Some report a shocking type pain that shoots down the leg. This could be from the needle rubbing against a nerve floating in the spinal fluid.

Others might find there can be difficulty on the anesthesiologists part in inserting the needle, causing pain or discomfort. A guided tap (performed under fluoroscopy) may prevent this while providing more peace of mind.

Be sure to let your anesthesiologist know if you feel any pain during or after this procedure.

While there are always bound to be people who have had a negative experience, find comfort in knowing some have no pain or issues at all.

It is often best after most medical procedures to take it easy. For spinal taps in particular however, you may be advised to lie flat as much as possible and consume large amounts of caffeine and fluids. Doing so will help the puncture site heal, especially if a leak was caused during the procedure.

While I have been able to resume mostly normal activities that same day, others may find there is discomfort that can last for days and possibly longer. It can be understandable to feel a tenderness, stiffness, or mild pain after a procedure like this. Some also report a burning sensation, likely due to nerves being aggravated during the procedure. Lower back pain or even leg pain can be common but should not last too long.

I cannot stress enough that if you feel any pain or discomfort that is concerning, please contact your healthcare team.

A therapeutic tap is a spinal tap that is performed with the goal of removing excess spinal fluid which in turn relieves pressure and pain.

Some IH patients may receive these regularly, though it is typically not advised. The spinal column is a very delicate area, and oftentimes the more you tamper with something, the more you are put at risk for other complications. Scar tissue may also build up to a significant level after multiple taps, making each new one increasingly difficult.

Therapeutic taps can be helpful at times though, and your healthcare team can work with you on whether it is recommended in your case. For other less invasive forms of therapeutic relief from high pressure, see medication options and natural remedies.

A spinal tap may be used to both measure opening pressure and to collect samples of spinal fluid for testing. A spinal tap can be used to help diagnose many conditions, including infections such as meningitis or encephalitis, brain/spinal cord cancer, neurological disorders, and multiple sclerosis. It can also be used to help rule out certain conditions.

Some, if not most, spinal taps are performed blind, while others may be performed under fluoroscopy where x-ray technology can help guide the anesthesiologist to the exact location they need to go for the puncture.

While I have undergone blind taps, I personally find I have more peace of mind when they are done under fluoroscopy.

A lumbar drain is more of an extended spinal tap. During this procedure, spinal fluid will be retrieved via vials as it is drained from the spine. This may be done to relieve any excess spinal fluid causing pressure upon the brain or spine by bringing you down from a higher opening pressure to a normal range.

Like with any medical procedure, there are risks associated with spinal taps. Your physician will have you read, understand, and sign a waiver prior to the procedure. Some of the risks may include (but are not limited to) bleeding at the site (often minimal), back pain, or a CSF leak (which may cause severe headaches). Nerve damage or infection are possible but considered a rare occurrence.

While some may fear paralysis from a lumbar puncture, the needle shouldn’t go anywhere near the actual spinal cord, as it ends closer to L1 and L2. As we stated above, spinal taps are often performed between L3 and L4.

Please be advised first and foremost by a medical professional on the risks and complications associated with a spinal tap.

Of course any trauma to our bodies, no matter if big or small, has the possibility of causing pain or discomfort. However, any pain that concerns you should be reported immediately to your healthcare team.

It is possible that during the tap, the nerves floating in the spinal column were aggravated by the needle. This may cause back pain or leg pain. This might present itself as a burning sensation.

Another possible side effect of a spinal tap is a spinal fluid leak, also known as Intracranial Hypotension. Occasionally, the needle to these lumbar punctures may pierce the dura of the spine and cause a spinal fluid leak. During a spinal fluid leak, the brain and/or spine begins to lack the “cushion” that it normal has from the spinal fluid. Painful headaches may occur as well as nausea, dizziness, trouble thinking, back pain, neck pain, etc. You may also notice the pain worsens while upright and is relieved by lying flat.

Be sure to advise your doctor immediately upon experiencing any of these symptoms. While a CSF leak can heal naturally over time, medical intervention, such as a blood patch, may also help.

It is also recommended if experiencing a CSF leak to lie flat and consume high amounts of fluids and caffeine.