A lumbar drain is indicated for various conditions, such as CSF leak, NPH, intraoperative CSF drainage, etc. It is usually placed under fluoroscopy, as shown in Case 1.
The patient is placed prone on the biplane table, with their lower back sterilized and draped.
(A): Adjust the A-plane image intensifier caudally and either in the LAO or RAO position to maximize the target—the window of the interlaminar spaces (red arrows).* The 14G Tuohy spinal needle is placed on the patient's back to localize the target. The skin underneath the needle tip is marked with a marker. Local anesthetic is then injected around the marker.
(B): Following the PA angle, the needle is gently advanced through the skin into the soft tissue. Take a PA view to aim the needle toward the target. Take a true lateral view to evaluate the depth of the needle tip.
(C and D): The needle tip is now advanced into the intrathecal space.
(E): After removing the inner stylus, the drain catheter was placed into the intrathecal space through the needle. Take a lateral view to confirm the catheter travels rostrally.
* The target should be below the L1/L2 level to avoid injury to the spinal cord/conus medullaris. In this case, the catheter enters the L3/L4 level.