Transforaminal Epidural Blood Patches for the Treatment of Postsurgical Dural Leaks: Two Case Reports

Unintended dural punctures with leakage of cerebrospinal fluid (CSF) are recognized as a frequent complication of spinal surgery. Although conservative or invasive options may be used to treat postoperative CSF leaks, the existing literature does not define either an algorithmic treatment approach or a universally accepted standard of care. We believe that a transforaminal epidural blood patch (EBP) can serve as a minimally invasive, cost-effective option to treat postsurgical CSF leaks that do not resolve with conservative management. We have performed an EBP via the transforaminal route to treat postsurgical CSF leaks in both the cervical and lumbar spine. The first case describes a patient who underwent an anterior cervical diskectomy and fusion with a complication of profuse CSF leakage. The application of a cervical transforaminal EBP at the levels of surgical repair was effective in stopping the dural leak. The second case involves a patient who experienced classic positional spinal headaches after a lumbar hemilaminectomy and diskectomy. After utilization of lumbar transforaminal EBPs, his symptoms revolved. This article presents the potential use of an EBP via the transforaminal route to treat postsurgical dural leaks in both the cervical and lumbar region.

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