There are many differences in fluoroscopy-guided lumbar puncture (FG-LP) technique among radiologists. Even within the same institution, there are a variety of preferences among proceduralists with individual perspectives based on the literature, training, and/or experience. Our aim is to provide familiarity with various techniques involved in FG-LP and provide insight on how to improve patient outcomes. The pertinent anatomy and physiology, indications, contraindications, patient management, complications of the procedure, and procedural techniques for performing an FG-LP are reviewed in detail. Potentially controversial topics regarding FG-LP are also addressed. There are many differences in fluoroscopy-guided lumbar puncture (FG-LP) technique among radiologists (1). Even within the same institution, there are a variety of individual preferences among physicians with different perspectives based on a combination of literature familiarity, training, and personal experience. Our aim is to provide familiarity with various techniques involved in FG-LP, improve efficiency, and improve patient outcomes. We will also address possible controversial issues regarding FG-LPs using an evidence-based approach.