A 35-year-old female SMA-3 patient with complete fusion of posterior elements, precluding a standard LP (a). Patient decided the TFLP method for drug administration. Panel (b) shows planning scout CT image with grids, allowing to decide the needle length and needle approach. In panel (c), the needle (arrows) is purposefully oriented to the most posterior border of the neural foramen, to hit the anterior margin of the lamina (dotted arrow). In panel (d), after hitting the bone, using simple needle manipulations, the needle (arrows) was successfully advanced into the thecal sac, without causing any radicular pain and damaging the exiting nerve roots. The patient had PLPH, which spontaneously resolved in the same day without any treatment.