Unintentional cervical dural tap treated with lumbar blood patch
Christophe Lebrun1, Dirk Peek, Pascal Vanelderen
1Department of Anesthesiology, Intensive Care, Emergency Care and Pain Therapy, AZ Turnhout, Turnhout, Belgium.
Pain Practice : the Official Journal of World Institute of Pain
|January 18, 2014
Summary
Post-dural puncture headache (PDPH) can occur after cervical epidural steroid injections. Lumbar epidural blood patches effectively treated cervical PDPH in two cases, offering symptom resolution or significant improvement.
Area of Science:
- Neurology
- Pain Management
- Anesthesiology
Background:
- Cervical radicular pain is often treated with epidural steroid injections.
- Interlaminar cervical epidural injections carry a risk of unintentional dural puncture, potentially leading to post-dural puncture headache (PDPH).
- The reported incidence of dural puncture during these procedures ranges from 0.25% to 2.65%.
Observation:
- This report details two cases of patients experiencing cervical PDPH following interlaminar epidural steroid injections.
- Both patients underwent treatment with an epidural blood patch, with varying degrees of success.
Findings:
- One patient experienced complete resolution of cervical PDPH symptoms after a lumbar epidural blood patch.
- The second patient showed significant improvement with a lumbar epidural blood patch, requiring a subsequent high thoracic blood patch for residual headache.
Implications:
- Epidural blood patching, particularly lumbar, can be an effective treatment for cervical PDPH.
- These cases highlight the utility of epidural blood patching for managing this rare complication of cervical epidural procedures.
- Further investigation into the efficacy and optimal placement of epidural blood patches for cervical PDPH is warranted.
