CT‐Guided Transfacet Lumbar Puncture in a Patient with Hyperlordosis with Suspected Normal Pressure Hydrocephalus

Patients are often referred to our interventional radiology department for technically difficult lumbar punctures. Technical difficulties and failure arise in patients with scoliosis, severe spondylosis, and obesity. In our patient with lumbar hyperlordosis who needed a lumbar puncture for suspected normal pressure hydrocephalus, the conventional median interspinous and paramedian interlaminar approaches for needle advancement were repeatedly unsuccessful. Under CT guidance, a transfacet approach was successful on the first pass. To our knowledge, there is no published article on this novel approach.