Table 2. Comparison of Techniques Used in a Lumbar Puncture Performed by an Anesthesia Provider and Dry Needling the Lumbar Multifidi Performed by a Physical Therapist.

	Lumbar Puncture	Dry Needling Multifidi
Needle diameter (gauge)	20-22 gauge	0.25-0.30 mm
Needle length	9 cm	40-100 mm
Patient position	Sitting or side-lying with flexion of the spine	Prone or prone over pillow
Needle approach	Midline (in the interspinous space) In some cases, a paramedian (off midline) approach is useda	1-4 cm lateral to spinous process
Needle angle	Slightly cephalad. In some cases, medially and superiorlya	0-45 degrees Medial or inferomedial
Use of imaging to ensure proper placement	Ultrasound-assisted techniquesb	Not a standard practice

^a In certain instances, such as increased age and spinal deformity, providers may employ a paramedian approach in which the spinal needle is placed off midline and directed medially and superiorly to avoid the interspinous space

^b Authors have also described ultrasound-assisted techniques to determine the interspinous level, midline, and depth to the ligamentum flavum²⁸