neurologic disorders
How To Do Lumbar Puncture
Positioning
The goal is to flex the lumbar spine to expand the intervertebral spaces. The patient may either lie in the lateral decubitus position or be seated. The lateral decubitus position is generally preferred and should be used if CSF manometry is desired. The sitting position may be helpful for obese patients and is preferred for infants. Lateral decubitus position:The patient lies on the side in a fetal position, with the hips flexed as much as is tolerable. Ensure the pelvis, back, and shoulders are perpendicular to the bed. Place a pillow under the head to align the head with the spine and between the knees for comfort if needed. An assistant can help the patient curl up as much as possible. Before beginning, assume a comfortable position close to the patient. Sitting position:The patient sits at the edge of the bed with their feet on a stool or chair to flex the hips, and leans forward with the head and shoulders resting on a bedside table. For an infant, an assistant holds the arms and legs from the front, maintaining the infant in a sitting fetal position on the bed. The head is also supported to prevent asphyxiation due to neck flexion. 