A lumbar puncture can be conducted with the patient sitting upright or in the lateral recumbent or prone positions. The lateral recumbent or prone positions are favored over the upright position because they allow for a more precise assessment of the opening pressure. However, excessive flexion can compromise the upper airway. For lumbar punctures conducted under fluoroscopic supervision, the prone position is commonly used. Both positions have their advantages and disadvantages. The position appropriate for the patient is used after the patient is assessed for comorbidities. In the lateral recumbent position: • The patient lies on his side with their head on the pillow to keep the spine straight • The torso and knees are flexed to maximize the interlaminar foramen of the vertebrae • Draw patient’s legs up to their chest. • Craniospinal and transverse planes should remain stable • Excessive flexion can compromise the upper airway. In the upright position: • Advantageous in patients with pulmonary disorders or airway compromise • Patients sit on the edge of the bed • The trunk is flexed by having the patient lean forward and resting elbows on a table or knees. • Less distortion of spinal anatomy hence extraction of the cerebrospinal fluid is easier.