Spine Procedures

Indications for Image Guided Lumbar Puncture

At UW, the Neuroradiology department performs lumbar punctures for those adult patients that require image guidance. The most common indication for image guidance is a failed LP on the floor/ER, potentially due to scoliosis, significant degenerative change, or large body habitus

Interested in ordering an image guided LP?

Some questions that the Neuroradiologist will ask you to help facilitate the procedure:

1) What is the indication/reason for the LP

2) Has someone on the floor/ER attempted to perform the LP?

3) Is the patient consentable? If not, who is the power of attorney and what is their contact information?

4) What is the INR, PTT and PLT count? We require labs on all inpatients/ER patients. Please refer to lab/medication guidelines for cutoff values.

5) Are there any potential issues that the radiologist should know prior to performing the LP? For example, the LP needs to be performed under conscious sedation or general anesthesia.

6) If the LP is to be done for intrathecal chemotherapy administration, is the chemotherapy ready and who will be available to administer the chemotherapy?

Guidelines for Head CT/MR prior to LP

Recommend Head CT in patients with signs/symptoms of increased intracranial pressure:

· New onset seizure

· Papilledema

· Focal neurologic findings

· Altered mental status

American College of Physicians: Practice Guidelines Lumbar Puncture. Physician Information and Education Resource. 2010.