Application of bedside ultrasound guidance in difficult diagnostic lumbar puncture in infectious diseases: Technical specifications, clinical evidence, and practical prospects.

Abstract

Diagnostic lumbar puncture is a core procedure in the diagnosis and management of infectious diseases. However, in patients with complex anatomical conditions, such as obesity and spinal deformities, the traditional blind puncture method is often challenging to perform, resulting in a substantially higher failure rates and increased complication risks. Bedside ultrasound guidance provides a precise, visual solution to these challenges and represents an emerging tool for improving clinical practice. This narrative review aimed to comprehensively examine the clinical value of ultrasound-guided lumbar puncture in infectious diseases, focusing on the current evidence base, core ultrasound technical principles, standardized pre-puncture assessment procedures, and clinical implementation strategies. Furthermore, it sought to empower infectious disease physicians to utilize safe, efficient, and scalable auxiliary techniques while outlining future directions. Compared with traditional landmark-based methods, ultrasound guidance significantly improves the first-attempt puncture success rate by approximately 20%-30%. Its key technical advantages include real-time visualization of the needle tip, identification of the optimal insertion point, and reduction of procedural complications.