METHODS : Initially, after radiographic and clinical evaluation, we attempt the lumbar puncture via midline approach with the needle orientation in a plane directed towards the saggital plane of the spine (in the direction of convexity). If redirection of needle fails to achieve the target, alternative technique like paramedian approach (with needle entry point slightly lateral to the convexity of spine) or Taylor’s approach is selected in accordance with the palpable bony landmarks. Difficulty in approaching the intrathecal space was observed to be higher if, in addition to scoliosis, the rotation of spine or the lumbar lordosis was severe.

RESULTS : -
CONCLUSIONS : The repetition of attempts during lumbar puncture in a kyphoscoliotic patient can be sharply reduced, if after radiographic and clinical evaluation, a 3D image of the possible orientation of spine is constructed in mind and lumbar puncture attempted thereafter.