Female, 19 years old, with right leg weakness and right and left patchy sensory changes, elevated systemic inflammatory markers. Clinical question: Please evaluate for CNS inflammation. The procedure, indications, benefits, risks/complications and alternatives were described to the patient and informed consent was obtained. The lumbar puncture was performed under general anesthesia. The general anesthesia was induced due to planned subsequent MR examination. The patient was placed in the prone position and the inferior back was prepped with Betadine, draped and anesthetized with 1% lidocaine subcutaneously and into the deeper soft tissues. Using fluoroscopic guidance, a 22 gauge x 5 inch spinal needle was localized into the thecal sac at the L3-L4 level. There was no immediate return of cerebrospinal fluid. Hence under fluoroscopic guidance, the spinal needle was localized into the thecal sac at L2-3 level. With valsalva maneuver ,there was immediate return of clear cerebral spinal fluid, approximately 3 ml of which was collected and and provided to the clinical service. The stylette was replaced, the needle removed, and hemostasis achieved with manual compression. The patient was then transferred to the MRI suite for MRI knee and spine under general anesthesia.
Successful fluoroscopy-guided lumbar puncture.Cumulative fluoroscopy time: 11.9 minutes.