Deformed spinal needle causing PDPH and dry tap due to blood clot

Postdural puncture headache (PDPH) is a significant complication of spinal anesthesia. There is considerable variability in the incidence of PDPH, which is affected by a number of factors including age, gender, pregnancy, and needle type and size. We present a case where a patient had PDPH after a spinal block with a deformed spinal needle due to calcified interspinous ligaments. We suggest, in the elderly patient with possible ligament calcification, an introducer needle should be used to achieve the spinal block and if there are multiple attempts then the needle should be checked for damage in between. Also, change in the resistance from previous tries or a gritting sensation during needle insertion should be taken seriously and the needle checked before further attempts are made.