Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands.
Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands.
Lancet Neurol. 2018 Mar;17(3):268-278. doi: 10.1016/S1474-4422(18)30033-4.
Technological advances have changed the indications for and the way in which lumbar puncture is done. Suspected CNS infection remains the most common indication for lumbar puncture, but new molecular techniques have broadened CSF analysis indications, such as the determination of neuronal autoantibodies in autoimmune encephalitis. New screening techniques have increased sensitvity for pathogen detection and can be used to identify pathogens that were previously unknown to cause CNS infections. Evidence suggests that potential treatments for neurodegenerative diseases, such as Alzheimer's disease, will rely on early detection of the disease with the use of CSF biomarkers. In addition to being used as a diagnostic tool, lumbar puncture can also be used to administer intrathecal treatments as shown by studies of antisense oligonucleotides in patients with spinal muscular atrophy. Lumbar puncture is generally a safe procedure but complications can occur, ranging from minor (eg, back pain) to potentially devastating (eg, cerebral herniation). Evidence that an atraumatic needle tip design reduces complications of lumbar puncture is compelling, and reinforces the need to change clinical practice.
技术进步改变了腰椎穿刺的适应证和方法。中枢神经系统感染仍然是腰椎穿刺最常见的适应证，但新的分子技术拓宽了脑脊液分析的适应证，如自身免疫性脑炎中神经元自身抗体的测定。新的筛选技术提高了病原体检测的敏感性，可用于鉴定以前未知的引起中枢神经系统感染的病原体。有证据表明，阿尔茨海默病等神经退行性疾病的潜在治疗方法将依赖于使用脑脊液生物标志物进行早期疾病检测。除了作为一种诊断工具外，腰椎穿刺还可用于鞘内治疗，如脊髓性肌萎缩症患者中使用反义寡核苷酸的研究所示。腰椎穿刺通常是一种安全的操作，但可能会发生并发症，从轻微（如背痛）到潜在的严重（如脑疝）不等。有证据表明，无创伤针尖设计可减少腰椎穿刺的并发症，这令人信服，因此需要改变临床实践。
