Lumbar punctures

A lumbar puncture involves inserting a hollow needle between 2 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 2 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 process 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 doctor or specially trained nurse will do the lumbar puncture. Your doctor or nurse will usually give you a local anaesthetic first. Then they will insert a hollow needle between 2 of the spinal bones in the lower back. This can be used to take a sample of cerebrospinal fluid (CSF) for testing.

A lumbar puncture can be done in an outpatients department or on a ward at the hospital. 

Intrathecal chemotherapy is when 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.


When 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:

  • some types of chemotherapy drugs
  • antibiotics
  • pain-relieving drugs
  • anaesthetics.


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. 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 you need it. You will 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 are going to have chemotherapy during the lumbar puncture. Specially trained staff will do the lumbar puncture in a special room of the hospital. Very rarely, you may have to travel to a different hospital if it cannot be done where you normally have your treatment.

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

  • the reasons for the lumbar puncture
  • what will be done
  • the chemotherapy treatment, if this is being given
  • any other tests or treatments that may be available
  • any risks or side effects of the lumbar puncture and chemotherapy.

It is 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 do not understand what you have been told, tell the staff straight away so they can explain again. Some medical treatments and procedures can be difficult to understand, so it is not unusual to need repeated explanations.

People sometimes feel that the hospital staff are too busy to answer their questions, but it is 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 will 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 there are small spaces between the bones of your spine (vertebrae).

The doctor or nurse will clean the skin over the lower part of your back with an antiseptic solution. They will then inject a local anaesthetic to numb the area and wait a few minutes for the anaesthetic to work.

They will then insert a hollow needle between 2 of the spinal bones and into the spinal canal.

You will need to stay very still while they do this. You may feel some pressure as the needle is put in. The doctor or nurse can then withdraw samples of CSF or inject chemotherapy drugs. Or they may do both.

There are very strict guidelines for giving chemotherapy in this way. The doctor and nurses will do a number of safety checks to make sure 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 having intravenous chemotherapy (into a vein) on the same day, you will have this first in the ward or day unit. 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 process normally takes around 20 minutes.

Having a lumbar puncture sitting up
Having a lumbar puncture sitting up

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Having a lumbar puncture lying down
Having a lumbar puncture lying down

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After the lumbar puncture

After the procedure, you will need to lie flat for a while. This may be from 1 hour to a few hours, depending on how you feel.

Having a lumbar puncture is not usually painful. Some people may find it uncomfortable or have a headache for a few hours afterwards. Tell your doctor or nurse if you have a headache, as they can give you mild painkillers to help. You will be able to move from side to side but sitting up can make a headache 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 will be able to get up and move around. But it is 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 are 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

Where can I have chemotherapy?

Usually chemotherapy is given in a chemotherapy day unit. Some may people stay in hospital, or have treatment at home.

How chemotherapy is given

Chemotherapy can be given in different ways depending on the type of cancer you have and your treatment plan.

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 is put into the arm to give chemotherapy and other medicines.