Transforaminal cervical blood patch for the treatment of pos. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. An epidural steroid injection is a pain management technique that can help you find relief from chronic neck, radicular pain, or back pain. We believe that a transforaminal epidural blood patch ebp can serve as a minimally invasive, costeffective option to treat postsurgical csf leaks that do not. The interlaminar approach is the most commonly used technique for an epidural blood patch.
An epidural blood patch is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. An epidural blood patch is a treatment for spinal headaches. Epidural blood patches are surgical procedures that use autologous blood to close one or more holes in the dura mater of the spinal cord. Patients on insulin will be following sliding scale to adjust for elevated sugar levels. Transforaminal epidural blood patch is appropriate for patients with intractable cerebrospinal fluid leak.
If these conservative and pharmacologic strategies do not achieve a satisfactory improvement in a reasonable time, an interventional approach should be considered. Epidural blood patch was performed at the t1 to t2 level, the presumed location of the leak due to presence of a bone spur on ct and the large corresponding csf collection. This is the first time i have seen a pdph as a result of a transforaminal esi. An epidural blood patch is a procedure that is reimbursed without regard for the time involved. An epidural blood patch may also help reduce other spinal fluid leak. Epidural blood patch technique, recovery, and success rate. Epidural patching medical clinical policy bulletins aetna. Elevated blood sugar is a known effect of steroid medication and may last for 24 days after the injection of steroids. Bilateral cervicothoracic transforaminal blood patches for. Patients with cerebrospinal fluid leakage due to rupture of the ventral side of the dura mater may be particularly good candidates for this procedure. We present a case report where transforaminal epidural blood patch was used successfully to manage persistent csf leak after laminectomy.
Postoperative cerebrospinal fluid leak managed with. The introduction of this blood acts to patch the hole in the dura the outer membrane of the spinal cord that was created by the needle at the time of myelography. Epidural blood patch ebp is a recognized treatment for spontaneous cerebrospinal fluid leak scfl and is typically administered. Transforaminal epidural blood patch pain physician. The blood clots, helping to patch punctures after a spinal tap procedure. Management of a ventral cerebrospinal fluid leak with a. This case report describes a patient with spinal headache after a transforaminal selective epidural injection in a post laminectomy patient that was treated with a. Lumbar transforaminal epidural blood patch pain medicine. After the injection of your blood, the bodys own healing system should take over and finish repairing the spinal fluid leak. An epidural blood patch is a procedure that removes a small amount of. A blood patch is a medical procedure that is used to close cerebral spinal fluid csf leaks.
Transforaminal epidural blood patch semantic scholar. Background and objective epidural blood patch ebp is a safe and effective treatment for spontaneous intracranial hypotension sih, but clinical and procedural variables that predict ebp efficacy remain nebulous. Pdf postoperative cerebrospinal fluid leak managed with. A second transforaminal ebp was performed again with almost immediate resolution. Fluoroscopically guided epidural injections of the cervical.
Epidural blood patch inpatient care what you need to know. You may be given a sedative before this procedure to make you more comfortable. Ct fluoroscopyguided blood patching of ventral csf leaks by. An epidural blood patch is an injection of your own blood into the epidural space, which surrounds the spinal cord. The blood is delivered into the epidural space of the spine, which is the area between the protective covering dura of the spinal cord and the bony vertebrae using fluoroscopic xray guidance. Epidural blood patch ebp is a recognized treatment for spontaneous cerebrospinal fluid leak. Learn more about this minimally invasive procedure from the experts at newtonwellesley hospital s pain management service. Lumbar transforaminal injection tufts medical center. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. Bilateral transforaminal epidural blood patches were performed in order to deliver blood to the ventral epidural space at the site of the tear identified on magnetic resonance imaging. The epidural blood patch method is identical to an epidural interlaminar injection and differs only in that autologous blood rather than a steroid mixture is injected. Epidural blood patch ebp is a recognized treatment for spontaneous cerebrospinal fluid leak scfl and is typically administered by the interlaminar approach. We present a case of successful treatment of postdural puncture headache pdph using a lumbar transforaminal epidural blood patch tfebp. This case report describes a patient who was treated with a transforaminal epidural blood patch for postdural puncture headache following an acupuncture procedure on his lower back after two epidural blood patches using an interlaminar approach had failed.
The transforaminal technique may be useful in patients who have failed conventional treatment, though a high degree of interventional experience and vigilance is required to safely perform this procedure. The procedure can be done blind or under fluoroscopic or ct guidance, and is performed predominantly by radiologists and anesthesiologists. This type of headache is often selflimiting, although in persistent cases, a blood patch may be necessary to alleviate the headache. A healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. An epidural blood patch is a relatively easy and effective option to treat postdural puncture headache by sealing the puncture site with 1020 ml of autologous blood. Less serious effects such as increased pain, central steroid effect, and allergic reaction occurred in transforaminal epidural steroid injections. We believe that a transforaminal epidural blood patch ebp can serve as a minimally invasive, costeffective option to treat postsurgical csf leaks that do not resolve with conservative management.
A transforaminal epidural steroid injection refers to how the needles are placed during the procedure. After the procedure, the patient had a severe headache and the conservative treatment was not effective. In cases, with inability to perform interlaminar blood patch, a transforaminal approach may be considered. The patient remains headachefree almost six months from the time of first tf blood patch. He was able to show presence of blood in the epidural space at the cervical levels on postprocedure mris. Objective postdural puncture headache pdph is an uncommon sequel of lumbar puncture in children. An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. In this patient, a fluoroscopically guided transforaminal epidural blood patch proved to be more effective than the classic blind interlaminar approach in the treatment of postdural puncture headache. Lumbar transforaminal epidural blood patch request pdf. We have performed an ebp via the transforaminal route to treat postsurgical csf leaks in both the cervical and lumbar spine. An epidural blood patch is a procedure using only your own blood. Transforaminal epidural blood patch for intractable. This case demonstrates that transforaminal epidural blood patch can be an effective in the treatment of chronic headache secondary to intracranial hypotension when traditional interlaminar technique is either impractical or has been previously ineffective.
We present a case of successful treatment of postdural puncture headache pdph using a lumbar. Epidural blood patch may be used to treat postduralpuncture headache, leakage of cerebrospinal fluid due to accidental dural puncture occurring in approximately 1. This procedure is done when there is a leak of cerebrospinal fluid into. These have all been updated for the 2014 changes from the centers for medicare and medicaid services cms. Procedural predictors of epidural blood patch efficacy in. The patient underwent left transforaminal epidural injections at l5 and s1 for management of chronic low back pain secondary to post laminectomy syndrome. Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. Transforaminal epidural blood patches for the treatment of. The blood patch procedure consists of an injection at the spinal tap site of a small quantity of autologous blood. This quickly led to resolution of the headache and cranial nerve palsies, and later to the complete resolution of his sdh. Apr 17, 2020 a transforaminal epidural, sometimes called a epidural glucocorticoid injection, is a shot given to the spinal nerve to relieve extreme back or leg pain. These injections can help you reduce pain, increase your mobility, and avoid or delay the need for.
The headache was immediately relieved and remained alleviated through the followup interval of 1 yr. When conservative treatment with bed rest, hydration, and caffeine are ineffective, epidural blood patches are recommended and are generally effective. Bilateral cervicothoracic transforaminal blood patches for p. Targeted transforaminal epidural blood patch for postdural. Transforaminal epidural blood patch for intractable spontaneous. The transforaminal blood patch technique under fluoroscopy has been reported, 3 456 and the use of ct guidance for nonselective lateral epidural access has as well. The mean spread of the blood patch in the epidural space has been found to be 4. Epidural blood patch an overview sciencedirect topics. Transforaminal blood patch for the treatment of chronic. Contraindications to performing a blood patch include septicemia. This is the first published report of the use of transforaminal epidural blood patches for the successful treatment of a headache lasting longer than 3 months. Lumbar transforaminal esi and pdph, blood patch student. It is done for patients experiencing severe headaches after receiving a spinal injection. I was thinking to try a blood patch in 2 to 3 days if not better, although she is scared understandably about undergoing any more injection procedures.
Usually, it is given to allow the patient time to heal from an injury, to work on physical therapy exercises, and sometimes as a method of avoiding possible surgery. Here, we report a case of a patient in whom scfl failed to resolve after three applications of interlaminar ebps before finally being successfully treated with transforaminal ebp. Transforaminal epidural blood patch for intractable spontaneous cerebrospinal fluid leak. The transforaminal technique may be useful in patients who have failed conventional treatment, though a high degree of interventional experience and vigilance is. If so you might be given instructions not to eat or drink for a period of time before your scheduled blood patch. These headaches occur as a result of spinal fluid leaking into the epidural space. Transforaminal epidural blood patch was performed utilizing 2 ml of autologous blood at each of the two sites.
The two interlaminar epidural blood patches at the l2 3. This is the first published report of the use of transforaminal epidural blood. Ctguided epidural blood patching of directly observed or. The injections increase pressure in both the epidural. Epidural blood patch ebp is a recognized treatment for spontaneous cerebrospinal fluid leak scfl and is typically administered by the. In the procedure, a doctor will take a blood sample from a patient and then inject that blood back into a hole in the epidural space. An epidural blood patch is a minimally invasive procedure used to treat a puncture of the dura, a membrane in the spine. Epidural blood patch what is an epidural blood patch why. The purpose of this report was to highlight that when lumbar epidural blood patches fail to eliminate pdph, diagnostic evaluation should be. A small amount of the patients own blood is injected into the epidural space, clotting and closing the site of puncture.
Although epidural steroid injections are frequently used to manage lumbar spinal pain, a number of complications may arise. A csf leak can occur when there is a tear or puncture in the dura the membrane that surrounds the brain and spinal cord that causes the watery protective fluid csf that circulates around these neurological structures to leak out. Transforaminal cervical blood patch for the treatment of. A small number of patients usually less then 10% may need to have a second blood patch.