"Appropriate patient positioning for lumbar puncture and location of the L4/L5 intercostal space"-McMaster Textbook of Internal Medicine 



Place the patient in the lateral decubitus position, close to the edge of the examination table, with the patient’s back facing you. Lower limbs should be flexed at knees and hips, knees pulled against the abdomen, head at maximum flexion towards the knees (Figure 1). Avoid excessive flexion of the spine; it should form a single line in one plane. The back and shoulders should be aligned in a plane perpendicular to the table. The procedure can also be done in a cooperative patient in a sitting position and under fluoroscopic guidance in a prone position.



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