Lumbar puncture and intrathecal chemotherapy

A lumbar puncture involves inserting a hollow needle between two of the spinal bones. This can be used to take a sample of cerebrospinal fluid (CSF) for testing. CSF is the fluid that surrounds and protects the brain and the spinal cord. A lumbar puncture can also be used to give chemotherapy. This is called intrathecal chemotherapy.

Intrathecal chemotherapy may be given if a cancer has spread to the CSF, or if there is a risk it could. This may happen in some types of leukaemia or lymphoma.

Before a lumbar puncture, the doctor will numb an area of skin over your spine with local anaesthetic. After a few minutes, they will gently insert a needle between two of the spinal bones and into the CSF. If you are having intrathecal chemotherapy, your doctor will inject the chemotherapy through the needle into the CSF. The whole procedure normally takes around 20 minutes.

Having a lumbar puncture is not usually painful, although some people may find it uncomfortable. The most common side effect of a lumbar puncture is a headache. To help prevent this, you need to lie flat for a few hours afterwards and drink plenty of fluids.

What is a lumbar puncture?

A lumbar puncture is a medical procedure which involves inserting a hollow needle between the spinal bones of the lower back, into the fluid which surrounds the lower part of the spinal cord. This fluid is called the cerebrospinal fluid (CSF). A sample of this fluid is usually taken to be tested in the laboratory.

A doctor or specially trained nurse will do the lumbar puncture. It can be done in an outpatients department or on a ward at the hospital. Lumbar punctures are usually carried out using a local anaesthetic. Intrathecal chemotherapy is where chemotherapy is given into the fluid around the spinal cord during a lumbar puncture.


Cerebrospinal fluid (CSF)

The cerebrospinal fluid (CSF) is a watery fluid which surrounds the brain and spinal cord. The CSF protects the brain and spine from injury by acting as a cushion.


Why a lumbar puncture may be used

A lumbar puncture may be used:

  • to take a sample of CSF to help doctors make a diagnosis; for example, to look for infection or cancer cells in the CSF
  • to measure the pressure of the CSF.

A lumbar puncture may also be used to inject a drug into the CSF. These drugs may include:


When intrathecal chemotherapy may be used

In some cancers, such as some types of leukaemia or lymphoma, cancer cells can pass into the CSF. Chemotherapy given into a vein or by mouth cannot easily get into the CSF. For that reason, intrathecal chemotherapy may be given if a cancer has spread to the CSF, or if there is a risk it could.

Only certain chemotherapy drugs can be given in this way. The chemotherapy drugs that are most commonly given intrathecally (with a lumbar puncture) are:

Steroids can also be given this way.


Before the lumbar puncture

Before your lumbar puncture, your doctor will explain why this procedure is needed. You’ll be asked to sign a form saying that you give your permission (consent) for the hospital staff to do the lumbar puncture.

You will also be asked to sign a form if you’re going to have chemotherapy during the lumbar puncture. Specially trained staff will do the lumbar puncture in a particular room of the hospital. Very rarely, you may have to travel to a different hospital if it can't be done where you normally have your treatment.

Before you are asked to sign the consent form, you should be given full information about:

It's a good idea to have a relative or friend with you when the procedure is explained, to help you remember the discussion. You may also find it useful to write down a list of questions before you go to your appointment.

If you don't understand what you've been told, let the staff know straight away so they can explain again. Some medical treatments and procedures can be difficult to understand, so it’s not unusual to need repeated explanations.

People sometimes feel that the hospital staff are too busy to answer their questions, but it's important for you to know how the lumbar puncture is likely to affect you. The staff should be willing to make time for your questions.


Having the lumbar puncture

You will have your blood pressure and pulse checked just before the lumbar puncture. As you will need to lie flat for some time after the procedure, you may find it helpful to go to the toilet beforehand. 

During your lumbar puncture, you’ll be asked to either:

  • lie on one side with your knees pulled up towards your chest
  • sit up, bending forwards over a table and supported by pillows.

These positions allow 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 part of your back is then cleaned with an antiseptic solution. After this, 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 then inserted between two of the spinal bones and into the spinal canal.

You’ll need to stay as still as possible during this time. You may feel a sensation of pressure as the needle is put in. Samples of CSF may then be withdrawn or chemotherapy drugs may be injected, or you may have both done.

There are very strict guidelines for giving chemotherapy in this way. The doctor and nurses will do a number of safety checks to ensure you are only given the medicines that have been prescribed for you, and this can take time. There may be extra nurses or doctors in the room to do the safety checks. If you would like to, you can also check the drugs before they are given.

If you are also having chemotherapy into a vein (known as intravenous chemotherapy), you will be given this first. The intrathecal chemotherapy will only be given after the other chemotherapy has finished.

After the lumbar puncture has been completed, the needle is removed and a small dressing is placed over the injection area. The whole procedure normally takes around 20 minutes.

Lumbar puncture being done lying down
Lumbar puncture being done lying down

View a large version

Read a description of this image

Lumbar puncture being done sitting up
Lumbar puncture being done sitting up

View a large version

Read a description of this image


After the lumbar puncture

After the procedure, you’ll need to lie flat for a certain amount of time. This may be from one hour to a few hours, depending on how you feel.

Having a lumbar puncture is not usually painful, although some people may find it uncomfortable. Some people may have a headache for a few hours afterwards. Let the doctor or nurse know if you have a headache, as they can give you mild painkillers to help. You’ll be able to move from side to side but, if you have a headache, sitting up can make it worse.

You will normally 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. However, 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. For example, if you’re having intrathecal chemotherapy, you may need several doses and will need to have a lumbar puncture each time.

If you have any questions about lumbar punctures or intrathecal chemotherapy, ask your doctor or nurse at the hospital where you are being treated.

Back to Being treated with chemotherapy

When is chemotherapy used?

Getting information about chemotherapy and its side effects can help you to plan and feel more in control.

Intrathecal chemotherapy

For ALL, chemotherapy may be given into the fluid surrounding the spinal cord. This is called intrathecal chemotherapy.

Central lines

A central line is a long, thin hollow tube. It is inserted into a vein in your chest to give chemotherapy and other drugs.

Implantable ports

An implantable port is a tube with a rubber disc at the end. It is inserted into a vein to give chemotherapy or other medicines.

PICC lines

A PICC line is a long, thin, flexible tube known as a catheter. It’s put into the arm to give chemotherapy and other medicines.