The paramedian approach to the lumbar puncture is a great alternative to the traditional midline approach, and it’s ideal for patients who are difficult to position. Advantages are the larger target of the intralaminar space, avoidance of spinous ligaments, and increased first-attempt success. This procedure does have limitations with obese patients in whom landmarks are not identifiable.
Dr. Crespo is an emergency physician at MetroHealth Medical Center in Cleveland.
Dr. Jones is director of the emergency ultrasound and the emergency ultrasound fellowship at MetroHealth Medical Center and associate professor at Case Western Reserve University School of Medicine, both in Cleveland.
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