The Center for Neuroimaging routinely performs lumbar punctures on inpatients and outpatients under fluoroscopic guidance for the referring services. Lumbar punctures may be requested for diagnostic purposes in difficult patients, for therapeutic cerebrospinal fluid (CSF) drainage, or for the injection of chemotherapeutic, gene therapy, or radiopharmaceutical agents to ensure safe subarachnoid injections. Intrathecal injections for subsequent CTs of the cervical, thoracic, and/or lumbar spine on inpatients and outpatients are also performed for the referring services. These procedures require lumbar or cervical punctures under fluoroscopic guidance. Complications related to intrathecal contrast have not been an issue so the only complications relate to the needle punctures themselves causing CSF leaks and symptoms of CSF hypotension. The complication rate has been measured by reviewing secondary diagnoses and supplementary manual review of the electronic medical record to identify complications that were a direct result of these procedures and required blood patches to resolve symptoms of CSF hypotension. Quarterly review during 2021 demonstrates that the complication rate was approximately 1.1% in nearly 1500 patients. Since 2016, the rate has been just 1% for nearly 7300 patients.