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. 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. The position that is most appropriate for the patient is usually chosen, but sometimes the LP is performed with the patient sitting and an opening pressure is required. In this case, the stylet is removed and the patient is positioned into the left lateral recumbent position with assistance. This happens in the case of pseudotumor cerebri. There is no evidence that changing the position of the patient increases the risk of spinal headache or transection of the spinal nerves. However, during this manoeuvre, be careful not to modify the direction of the spinal needle.