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This information is about having a lumbar puncture and intrathecal chemotherapy.
A lumbar puncture is a procedure in which a hollow needle is inserted between the bones of the lower back and into the fluid around the lower part of the spinal cord. A sample of the fluid may then be drawn off to be examined in the laboratory by a pathologist. A pathologist is a doctor who specialises in diagnosing disease by looking at body tissues and cells.
A lumbar puncture is carried out by a doctor or sometimes a specially trained nurse. It can be done in the outpatients department or on a ward at the hospital. Lumbar punctures are usually carried out under local anaesthetic. However, lumbar punctures for children are sometimes carried out under general anaesthetic.
Intrathecal chemotherapy is where chemotherapy| is given into the fluid around the spinal cord during a lumbar puncture.
Surrounding the brain and spinal cord is a watery fluid known as cerebrospinal fluid (CSF). The CSF protects the brain and spine from injury by acting as a shock absorber.
The brain and spinal cord are known as the central nervous system.
There are a number of reasons why a lumbar puncture may be necessary.
Changes in the CSF can help doctors diagnose diseases of the brain and nervous system. The fluid that is drawn off is sent to the laboratory, where it is examined under a microscope. In some types of cancer, tiny cancer cells can spread into the CSF, affecting the brain and more rarely, the spinal cord. By taking a sample of the CSF, doctors can see whether it contains any cancer cells.
A lumbar puncture may also be used to inject chemotherapy drugs into the CSF. This can be done for people whose cancer has spread into the CSF or to help prevent it from happening. Injecting chemotherapy into the CSF is known as intrathecal chemotherapy.
Other reasons for doing a lumbar puncture are:
Before your lumbar puncture, your doctor will explain why it is recommended that you have this test, and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to do the lumbar puncture.
If you are going to have chemotherapy during the lumbar puncture, you will also be asked to sign a form to agree to have this. The lumbar puncture will be done by specially trained staff and in a particular room of the hospital. Very occasionally, you may have to travel to a different hospital if it can't be done where you normally have your treatment because there aren't any specially trained medical staff.
Before you are asked to sign the consent form you should have been given full information about:
If you don't understand what you've been told, let the staff know straight away so they can explain again. It isn't unusual for people to need repeated explanations.
It's often a good idea to have a relative or friend with you when the procedure is explained to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.
People often feel that the hospital staff are too busy to answer their questions, but it's important for you to be aware of how the lumbar puncture is likely to affect you, and the staff should be willing to make time for your questions.
You'll have your blood pressure and pulse checked before your lumbar puncture. You may also find it helpful to go to the toilet beforehand, as you will need to lie flat for some time following the procedure.
During your lumbar puncture, you will be asked to either lie on one side with your knees drawn up towards your chest or to sit up, bent over a table and supported by pillows. This positioning allows your back to curve as much as possible so that the bones of the spine (vertebrae) are widely separated.
The area of skin over the lower spine is cleaned with an antiseptic solution. Local anaesthetic is injected to numb the area. The doctor or nurse will wait for a few minutes for the anaesthetic to take effect.
A hollow needle is inserted between two of the spinal bones and into the spinal canal.
An illustration of a lumbar puncture being done
View a large copy of the illustration showing a lumbar puncture being done|
You'll need to stay as still as possible at this time. You may feel a sensation of pressure as the needle is put in. Samples of CSF may then be withdrawn and/or chemotherapy drugs may be inserted.
If chemotherapy drugs are being given, the doctor and nurses will do a number of safety checks to ensure you are given only the medicines that have been prescribed for you. This is because only certain drugs can be given in this way. If you would like to, you can also check the drugs before they are given.
If you are also having chemotherapy into a vein (intravenous chemotherapy), the intrathecal chemotherapy will usually be given after the other chemotherapy has finished.
After the lumbar puncture has been completed, the needle is removed and a small dressing is put on. The entire procedure normally takes around 20 minutes, although this can vary depending on the reasons why it is being done.
Lumbar puncture is not usually painful, although some people may find it uncomfortable. Some people may have a headache for a few hours afterwards. You will need to lie flat for a while after the procedure – from one hour to several hours, depending on how you feel. You will be able to roll from side to side, but if you have a headache, sitting up can make it worse.
Let the doctor or nurse know if you have a headache, as mild painkillers can be given to help. You will also have your blood pressure and pulse checked again during this time. Ask the doctor or nurse when it will be safe for you to sit up. Once you have rested and feel well, you can safely return to your normal activities, although it's best not to drive or operate machinery for 24 hours after a lumbar puncture.
Sometimes a lumbar puncture is done more than once. Often, several doses (cycles) of chemotherapy are needed and a lumbar puncture will be done during every cycle until all of the planned treatment is completed.
This section has been compiled using information from a number of reliable sources, including:
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