60 elderly patients scheduled for an elective lower-extremity fracture surgery were randomized to receive spinal anesthetic injection at at the L3-4 region via a lateral crypt approach or a vertical approach. the outcomes of interest included the success rate of injection, number of attempts per puncture, and the incidence of adverse events (nerve root irritant symptoms, back pain, headache, bleeding). Results revealed no significant differences between the lateral crypt and vertical approach groups in all outcomes. No cases of back pain, headache, bleeding, or other adverse reactions were observed in either group.