"The lumbar spinous processes of L3, L4, and L5, and the interspaces between can usually be directly identified by fluoroscopy. The conus medullaris (or terminal part) of the spinal cord most commonly ends at the L1/2 intervertebral disc level in children and adults 5,6. Thus, the spinal needle can be safely inserted under fluoroscopic guidance at L3-L4 or L4-L5 via a right oblique sublaminar approach since this is well below the conus."
"The lumbar spinous processes of L3, L4, and L5, and the interspaces between can usually be directly identified by fluoroscopy. The conus medullaris (or terminal part) of the spinal cord most commonly ends at the L1/2 intervertebral disc level in children and adults 5,6. Thus, the spinal needle can be safely inserted under fluoroscopic guidance at L3-L4 or L4-L5 via a right oblique sublaminar approach since this is well below the conus."
"Once numb, a spinal needle is inserted under strict aseptic conditions using intermittent-pulse fluoroscopy to identify the appropriate site for the LP (often L2-L3 or L3-L4 intervertebral space). The course of the advancing needle is monitored during the procedure until the subarachnoid space is entered via a left or right oblique sublaminar approach, which is confirmed by the reflux of clear CSF. Needle position can be assessed with a lateral projection if there is uncertainty about depth."
"Once numb, a spinal needle is inserted under strict aseptic conditions using intermittent-pulse fluoroscopy to identify the appropriate site for the LP (often L2-L3 or L3-L4 intervertebral space). The course of the advancing needle is monitored during the procedure until the subarachnoid space is entered via a left or right oblique sublaminar approach, which is confirmed by the reflux of clear CSF. Needle position can be assessed with a lateral projection if there is uncertainty about depth."
Expected headings
"Preprocedural evaluation"
"Positioning/room set up"
"Opening pressure measurement"
"CSF collection"
"Fluoroscopy-guided lumbar puncture (LP) is a minimally invasive, image-guided diagnostic and therapeutic procedure that involves the removal of a small volume of cerebrospinal fluid (CSF) from, or an injection of medication or other substance (e.g. radiotracer, chemotherapy agents) into the lumbar cistern of the spinal column. In addition to improving success rates, fluoroscopic guidance may reduce the incidence of a so-called traumatic LP (the presence of xanthochromia in the CSF sample could indicate a traumatic LP rather than subarachnoid haemorrhage in patients with multiple LP attempts)."
"Fluoroscopy-guided lumbar puncture (LP) is a minimally invasive, image-guided diagnostic and therapeutic procedure that involves the removal of a small volume of cerebrospinal fluid (CSF) from, or an injection of medication or other substance (e.g. radiotracer, chemotherapy agents) into the lumbar cistern of the spinal column. In addition to improving success rates, fluoroscopic guidance may reduce the incidence of a so-called traumatic LP (the presence of xanthochromia in the CSF sample could indicate a traumatic LP rather than subarachnoid haemorrhage in patients with multiple LP attempts)."