I have Burkitts Lymphoma and part of the treatment is a spinal tap. What can I expect and what can I do to lesson the side effects (headaches, back pain, etc...) Very nervous about the procedure, should I be???

Lumbar punctures, or spinal taps, are procedures that measure the cerebral spinal fluid (CSF) that is located in the space along the inside of your spine.  This procedure is necessary to help understand if your cancer has spread to other parts of your body, in this case your brain.  Because it is impossible to sample a patient's brain directly – you need your brain and cannot spare any of it! – instead, the pediatric oncologists will sample the CSF which surrounds and cushions your brain and also runs along your spinal cord.  If there is any cancer that has spread to the brain, then usually this can be detected in the spinal fluid as small, floating tumor cells.  It is important to know if tumor has spread to your brain, because this will affect the length and type of treatment you receive.

The procedure itself is fairly quick.  Often, the patient will lie down on his or her side.  Sometimes it is even done with the patient sitting up and leaning over.  Sometimes, patients will be given medicine to relax them or even put them to sleep before the spinal tap procedure.  Often, the skin is numbed with cream or lidocaine shots.  After the area is numb, a very thin needle is inserted into the spinal space at approximately the same level as the top of your hips.  Once the needle is far enough, a small amount of the CSF is collected for the lab to analyze for the presence of tumor cells.  The part that hurts the most is the needle going in, but it does not hurt when the CSF is coming out.

After the procedure is complete (usually less than five minutes) the needle is removed and the area is cleaned off.  Often, the patient is asked to lie on his or her back for 30 minutes to help apply pressure and avoid headaches.  I find that for my patients, drinking lots of fluid – or giving fluid through an IV after the procedure – tends to help reduce headaches.  Some physicians have even recommended caffeine (from soda) to help with headaches.  Not all patients will get headaches, and every patient responds differently to the procedure.  As always, if you do get a headache, it's important to ask your doctor which medicines are okay for you to take.

This would be a great topic for others to share their experiences and to teach us what works best for you during and after spinal taps!  Keep those questions coming.

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