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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • put gloves on
  • put a drape on top of the patient
  • clean the area e.g. with betadine
  • anaesthetise the skin and subcutaneous tissues with 1% lignocaine at the chosen site
  • place the spinal needle in the interspace with the bevel uppermost and advance it towards the umbilicus keeping it parallel to the ground
  • when advancing the needle consider:
    • when there is an increase in resistance as you go into the tough ligamentum flavum and a marked reduction of resistance when the needle passes through. When through the ligamentum flavum, the dura is very close (1-2mm away) and the needle should be slowly advanced and the stylet withdrawn after each step
    • when the dura is reached there should be a free flow of cerebrospinal fluid (CSF)
  • measure the opening pressure with a manometer - if greater than 40 cm of water, remove needle immediately to avoid brain stem herniation. Normal pressure is 6-20 cm of water

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