To review the evidence on ultrasound-assisted lumbar puncture (USLP) and evaluate its applicability for broader adoption in neurology.

Lumbar puncture (LP) is essential for diagnosing many neurologic conditions. However, landmark-guided LPs can be technically challenging, with failure rates up to 28%, especially in patients with obesity, prior surgery, or altered anatomy. These difficulties can delay diagnosis and treatment of time-sensitive conditions. Ultrasound-assisted lumbar punctures (USLPs) have emerged as a possible method to improve success rates and reduce complications. However, USLP remains underutilized in neurology, with lack of exposure and formal training contributing to slow adoption.

A narrative review was conducted using PubMed and Google Scholar. Search terms included “lumbar puncture,” “ultrasound,” “POCUS,” and “neurology.” Themes emerging from the literature were synthesized, including outcome comparisons between USLP and landmark-based LP, patients who benefit most from USLP, and the growing reliance on radiology for LPs. Additional literature describing ultrasound and lumbar puncture training was also reviewed.

Across multiple studies and meta-analyses, USLP increased first-attempt success rate, reduced traumatic taps, shortened procedure time, and lowered pain scores. These benefits were particularly pronounced in patients with obesity or altered spinal anatomy. Studies that reported no significant difference between USLP and landmark-based LP tended to have limited sample sizes and heterogeneous methodologies. Since referring LPs to radiology is both costly and time consuming, incorporating USLP into neurology practice may empower neurologists to independently perform difficult LPs.

Broader integration of USLP into neurologic practice can enhance bedside procedure success, decrease dependence on radiology, and strengthen neurologists’ capacity for efficient, high-quality diagnostic procedures. Further studies should explore the optimal educational approach for a structured USLP curriculum, geared towards neurology trainees and grounded in competency-based medical education principles.