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Case report
Successful transforaminal epidural blood patch in a patient with multilevel spinal fusion
  1. Hanwool Ryan Choi,
  2. Benjamin Fuller and
  3. Michael Magdy Bottros
  1. Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
  1. Correspondence to Dr Hanwool Ryan Choi, Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, MO 63110, USA; hchoi22{at}wustl.edu

Abstract

Introduction Epidural blood patch (EBP) is a vital tool in treating postdural puncture headache (PDPH). Traditional interlaminar epidural needle insertion into the epidural space, however, may be challenging due to anatomical variations. As an alternative method, we successfully performed an EBP via transforaminal approach.

Case report A mid-50-year-old male patient with multilevel spinal fusion developed PDPH after a failed spinal cord stimulator electrode placement. A transforaminal EBP was carried out by injecting a total of 8 mL of autologous blood into the neuroforamen at the L1–L2 level bilaterally. Our patient’s positional headache resolved immediately after the procedure.

Discussion To our knowledge, this is the first case reported of a transforaminal EBP in a patient with diffuse epidural adhesive fibrosis secondary to multilevel laminectomies and spinal fusion. This case report highlights potential risks and benefits of this novel technique and also discusses its therapeutic mechanism of action. We believe that a transforaminal EBP should be considered in patients who are poor candidates for the traditional interlaminar EBP.

  • post-dural puncture headache
  • pain management
  • back pain
  • injections, spinal

https://doi.org/10.1136/rapm-2020-101487

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    Footnotes

    • Contributors HRC: drafting of the majority of the work and revision of the draft. BF: drafting of the abstract, revision of the draft and assistance with the figures. MMB: provision of the case, editing of the draft and approval for submission. All authors agreed to be accountable for all aspects of the work, including, but not limited to, the accuracy and the integrity of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.