title: Ultrasound guidance for lumbar puncture.
abstract: OBJECTIVE
  To review the literature and describe techniques to use ultrasound to guide performance of lumbar puncture (LP).
  
  
  RESULTS
  Ultrasound evaluation of the lumbar spine has been shown in randomized trials to improve LP success rates while reducing the number of attempts and the number of traumatic taps.
  
  
  CONCLUSIONS
  Ultrasound mapping of the lumbar spine reveals anatomical information that is not obtainable by physical examination, including depth of the ligamentum flavum, width of the interspinous spaces, and spinal bone abnormalities, including scoliosis. Using static ultrasound, the lumbar spine anatomy is visualized in transverse and longitudinal planes and the needle insertion site is marked. Using real-time ultrasound guidance, the needle tip is tracked in a paramedian plane as it traverses toward the ligamentum flavum. Future research should focus on efficient methods to train providers, cost-effectiveness of ultrasound-guided LP, and the role of new needle-tracking technologies to facilitate the procedure.
authors: Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors: Nilam J
authors: NJ
authors: Soni
authors: Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors: Ricardo
authors: R
authors: Franco-Sadud
authors: Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors: Daniel
authors: D
authors: Schnobrich
authors: Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors: Ria
authors: R
authors: Dancel
authors: Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors: David M
authors: DM
authors: Tierney
authors: Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors: Gerard
authors: G
authors: Salame
authors: Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors: Marcos I
authors: MI
authors: Restrepo
authors: Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors: Paul
authors: P
authors: McHardy