Complete Resolution of Chronic Postdural Puncture Headache from Cervical Decompression After Lumbar Epidural Blood
Gurtej Bajaj1, Hector Lopez Marquez1, Russell Bell1
1Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania.
Background:
Neuraxial procedures have the risk of causing dural compromise that leads to postdural puncture headaches (PDPH). PDPH is normally treated conservatively with oral agents, such as nonsteroidal anti-inflammatory drugs and caffeine, or invasively with epidural blood patches (EBP). There is a paucity of evidence for the use of lumbar EBP in cases where the suspected chronic dural defect is at the cervical level.
Case Report:
A 47-year-old patient who underwent C4-C6 posterior extension of fusion as well as right-sided C5-C6 foraminotomy subsequently developed chronic PDPH symptoms that were refractory to conservative interventions. A lumbar EBP was performed for suspected cervical dura compromise, with near-immediate resolution of symptoms that lasted for multiple months.
Conclusion:
Lumbar EBP should be considered in patients with suspected PDPH from cervical dural compromise, especially in the context of a prolonged clinical course or failure of conservative means.
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