Drain, Lumbar

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.

Cases

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.