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To determine the optimal position for lumbar puncture in children, investigators measured interspinous process distances in a convenience sample of 28 children (age range, 6 weeks to 12 years) who presented to Yale-New Haven Children's Hospital. Patients undergoing lumbar puncture were excluded. Sonographers used a high-frequency linear transducer to measure the maximal space between spinous processes at L3-4 and L4-5 with each patient in five positions: (1) sitting with hips neutral, (2) sitting with hips flexed, (3) lateral recumbent with hips neutral, (4) lateral recumbent with hips flexed, and (5) lateral recumbent with hips and neck flexed.
Flexion of the hips significantly increased interspinous space in both the sitting and lateral po…