Testing 4 – This is (a) Spinal Tap
Next on this series of tests, it’s the turn of the lumbar puncture. After the radioactive excitement of a SPECT-CT Scan, this is decidedly more old school and apparently one of the most common tests used to diagnosis of MS.
A definition from the NHS
A lumbar puncture is where a thin needle is inserted between the bones in your lower spine. It shouldn’t be painful, but you may have a headache and some back pain for a few days.
A lumbar puncture may be used to take a sample of fluid from your spinal cord (cerebrospinal fluid) or measure the fluid’s pressure – to help diagnose a condition
The name alone is unpleasant. Could it not be something more friendly like a “Lumbar tickle”? Even a doctor friend of mine shudders at the thought of this.
The American name, Spinal Tap, at least raises a smile, thanks to “one of England’s loudest bands”.
So with all that in mind, what was it like?
I’d been in hospital for about three weeks and gone through the other tests before a lumbar puncture was suggested.
To begin with, a young doctor, Peter, explained the process. I had to sign a consent form which seemed unusual. This mentioned a risk of haemorrhage.
Given my lack of medical knowledge, my mind immediately went to “brain haemorrhage”. Fortunately, Peter assuaged these fears and explained that it was low risk and referred to bleeding around the needle. Probably not very pleasant either but not the scenario I immediately thought of.
It was onto the process itself and another glamorous moment. You lie on your side, with knees tucked in, almost a foetal position. I then received a number of injections of local anaesthetic in my back. After each one, Peter would touch my back and ask if I could feel anything.
The next few minutes went something like this:
Injection, wait a few minutes
Peter: can you feel this?
Another injection, wait a few more minutes
Peter: how about now?
Third injection, wait. Twiddle thumbs
Peter: how about now?
Fourth injection, wait, tum-te-tum.
Peter: can you feel anything now?
Me: feel what?
This may have been enough to tranquilise an elephant, but finally we were ready to puncture my lumbar.
The Lumbar Puncture
I could not feel the needle being inserted into my spine (phew) and because of my position, I could not see it either. Also not a bad thing.
After half an hour or so it was done. For whatever reason, I expected the extracted spinal fluid to be a cloudy, gloopy substance but it was actually looked like clear water. You learn something every day.
Following the lumbar puncture, several blood samples were taken. Partly to compare with the spinal fluid and also to check for other possible conditions.
When the tests came back, multiple sclerosis was mentioned for the first time since I entered the hospital.
Looking for Clues
This medical snippet from the MS Trust explains what the test found and what it meant.
“Oligoclonal bands. The immune system produces antibodies to fight infection. In MS, antibodies cross the blood-brain barrier and attack the myelin surrounding nerves. As a result, the level of antibodies in the cerebrospinal fluid of someone with MS is higher than it should be. It will also be higher than the level in the blood, so a blood sample will usually be analysed at the same time for comparison.
The test that shows the presence of antibodies is called electrophoresis. A sample of fluid is placed on a gel and voltage is applied. This causes antibodies of the same size to bunch together, forming visible ‘bands’.
One band (monoclonal) in the cerebrospinal fluid is normal. The term ‘oligoclonal bands’ refers to the presence of two or more bands and shows the presence of disease activity. Whilst this doesn’t necessarily mean that someone has MS, about 80-95% of people with MS do have oligoclonal banding in their cerebrospinal fluid.”
So after three weeks in hospital, I was a lot closer to diagnosis. It sounded…maybe better than some of the original options. I wasn’t sure what it really meant.
However, the lumbar puncture itself was a painless, if slightly uncomfortable process. More the lying position than the needle itself. I was pretty tired after it and my head felt like it had been hit with a sack of wet hammers. I had been warned about this so had plenty of water to rehydrate and laid down on the bed for a good while afterwards. In a bonus, apparently coffee is a good cure for the headaches post lumbar puncture. If only the hospital could do good coffee!
As horrible as it sounds, it isn’t that bad. If you are lucky enough to need a lumbar puncture, don’t think about it too much. Just close your eyes and turn the volume up to 11.