Ultrasound-Assisted Lumbar Puncture

In this narrative review, we examine the evidence on ultrasound-assisted lumbar puncture (USLP) and evaluate its applicability for broader adoption in neurology. Lumbar puncture (LP) is essential for diagnosing many neurologic conditions. However, landmark-guided LPs can be technically challenging, with failure rates up to 28%, especially in patients with obesity, prior surgery, or anatomic variations. These difficulties can delay diagnosis and treatment of time-sensitive conditions. Ultrasound-assisted LPs (USLPs) have emerged as a possible method to improve success rates and reduce complications. Limited neurologic literature on USLP suggests this technique may remain understudied and underutilized in neurology, with lack of exposure and formal training contributing to slow adoption. Across multiple studies and meta-analyses, USLP increased first-attempt success rate, reduced traumatic LPs, shortened procedure time, and lowered pain scores. These benefits were particularly pronounced in patients with obesity or spinal anatomical variations. Studies that reported no significant difference between USLP and landmark-based LP tended to have limited sample sizes and variability in study design, including differences in operator experience and definitions of procedural success. Since referring LPs to radiology for fluoroscopic guidance is both costly and time consuming, incorporating USLP into neurology practice may allow neurologists to independently perform difficult LPs. Broader integration of USLP into neurologic practice can enhance bedside procedure success, decrease dependence on radiology, and strengthen neurologists' capacity for efficient, high-quality diagnostic procedures. Further studies should explore current practices surrounding LP training and the effect of USLP on clinical and system-level outcomes in neurology settings.