The 66th
Scientific Meeting
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| 18S-052 |
Transforaminal blood patch for the treatment of post dural puncture headache
가톨릭대학교 의과대학 마취통증의학교실
Introduction
Post dural puncture headache (PDPH) is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. If conservative treatments are not successful, the epidural blood patch (EBP) is the gold standard of the treatment for dural puncture. The interlaminar approach is the most commonly used technique for EBP. We hereby describe a case of a patient who was treated with transforaminal EBP for PDPH that occurred after an acupuncture therapy.
Case
A 27-year-old male was referred to our pain clinic with persistent positional headache. He had L4-5 laminectomy 7 years ago. He underwent acupuncture therapy 9 days prior to presentation to our clinic for management of chronic low back pain caused by post laminectomy syndrome. The postural headache occurred and had lasted since the therapy. The patient was complaining of severe headache of NRS 9 that occurred upon sitting. A lumbar interlaminar EBP was performed using 15 ml of autologous blood at the L2-3 level. This failed to relieve the patient\'s symptoms. The MRI myelogram showed abnormal fluid signal intensity at left lumbar area, along the left paraspinal muscle and soft tissue at the L3-4-5 level probably due to CSF leakage. 4 days after the initial EBP, another interlaminar EBP was performed using 15 ml of autologous blood at the L4-5 level. The day after this procedure, the patient reported slight relief of the symptoms, but again experienced the same severe headache after 15 minutes of standing. The patient’s postural headaches persisted for 4 days, so we decided to perform a transforaminal epidural blood patch at the L3-4 and 4-5 level on the left side, the site of leakage in the MRI myelogram. 2.5 ml of autologous blood was instilled at the left L3-4 and L4-5 level, each. After the transforaminal EBPs, his headache finally subsided without any complication. After 4 days the patient was discharged. At 2-weeks follow-up, he reported being headache free with normalization of his activity level.
Concusion
This case demonstrates that the target transforaminal EBP can be a theraputic option in the treatment of PDPH when EBP using interlaminar approach is ineffective.
Reference
Lawrence Weil, Richard I. Gracer, and Neal Frauwirth, Transforaminal Epidural Blood Patch. Pain Physician 2007; 10:579-582.
Post dural puncture headache (PDPH) is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. If conservative treatments are not successful, the epidural blood patch (EBP) is the gold standard of the treatment for dural puncture. The interlaminar approach is the most commonly used technique for EBP. We hereby describe a case of a patient who was treated with transforaminal EBP for PDPH that occurred after an acupuncture therapy.
Case
A 27-year-old male was referred to our pain clinic with persistent positional headache. He had L4-5 laminectomy 7 years ago. He underwent acupuncture therapy 9 days prior to presentation to our clinic for management of chronic low back pain caused by post laminectomy syndrome. The postural headache occurred and had lasted since the therapy. The patient was complaining of severe headache of NRS 9 that occurred upon sitting. A lumbar interlaminar EBP was performed using 15 ml of autologous blood at the L2-3 level. This failed to relieve the patient\'s symptoms. The MRI myelogram showed abnormal fluid signal intensity at left lumbar area, along the left paraspinal muscle and soft tissue at the L3-4-5 level probably due to CSF leakage. 4 days after the initial EBP, another interlaminar EBP was performed using 15 ml of autologous blood at the L4-5 level. The day after this procedure, the patient reported slight relief of the symptoms, but again experienced the same severe headache after 15 minutes of standing. The patient’s postural headaches persisted for 4 days, so we decided to perform a transforaminal epidural blood patch at the L3-4 and 4-5 level on the left side, the site of leakage in the MRI myelogram. 2.5 ml of autologous blood was instilled at the left L3-4 and L4-5 level, each. After the transforaminal EBPs, his headache finally subsided without any complication. After 4 days the patient was discharged. At 2-weeks follow-up, he reported being headache free with normalization of his activity level.
Concusion
This case demonstrates that the target transforaminal EBP can be a theraputic option in the treatment of PDPH when EBP using interlaminar approach is ineffective.
Reference
Lawrence Weil, Richard I. Gracer, and Neal Frauwirth, Transforaminal Epidural Blood Patch. Pain Physician 2007; 10:579-582.
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