Conclusions
Though Lumbar puncture is widely performed, even at the level of primary care providers, without frequent complications, however one should tread cautiously while dealing patients with high risk of cerebral herniation or severe coagulopathy.25 A Check List helps before LP helps to improve confidence and avoids complications34. With the increase in the number of difficult LPs and intrathecal medications and sophisticated spinal prosthesis, there is an increase in the demand for image-guided LPs59. The intrathecal route is being increasingly used for administering various medications, but the proper doses and dosing schedules are still under research. There is convincing evidence that an atraumatic needle tip results in lower rate of complications and, therefore emphasizes the need to increase the awareness among physicians to change the current practice.36Outpatient LP is as effective and safe as inpatient LP and can help reduce the burden of admission and cost31. Newer CSF biomarkers may pave the way for earlier diagnosis of neurodegenerative diseases68. The practice of deferring LP until after brain MRI probably may not be helpful in situations where performing LP is vital.64 Certain clinical features should warrant performing imaging before LP in suspected meningitis instead of routinely performing imaging in every patient before LP67.