Pediatric lumbar puncture

 

Procedure

In this procedure (clinical) the needle is passed from the back into the skin between L2 and  L3, or  L3 and  L4 or sometimes below  L5. But  L2 and  L3 is widely used. The needle passes through the following layers

bullet Skin
bullet Fascia
bullet Interspinous and sacrospinous ligaments
bullet Erector spinae tendons
bullet Posterior longitudinal ligament
bullet Intervertebral disc
bullet Anterior longitudinal ligament
bullet Ligamentum flavum
bullet

Dura mater

bullet

Arachnoid mater

bullet

Subarachnoid space

It is usually done either for anesthesia spinal anesthesia or to obtain cerebrospinal fluid to test for meningitis or encephalitis.
L5 level is obtained using the level of the iliac crest as landmark. Hence, the appropriate spinal cord level is obtained either between  L2 &  L3 or between  L3 &  L4 in order to use the intervertebral disc. for lumbar puncture. A pin is passed through this disc, ligamentum flavum and it pierces the dura mater and arachnoid mater to reach the subarachnoid space. This is the expended lumbar cistern below the conus medullaris. At S L2 or below, only the epidural space can be approached because of the fusion of the dura mater with the coccygeal ligament. Epidural anesthesia may be used for child birth and other operations especially in the perineum. This blocks the pudendal nerve. ( S2  S4).
The
denticulate ligament covers external aspect of
dura mater while external to the denticulate ligament is the ligamentum flavum.
 

Adult lumbar puncture

 

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Pediatric lumbar puncture

 

                 

 

 

 

 

 

 

 

 

 

 

 

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