1. 2007;10;579-582Transforaminal Epidural Blood Patch
   Case Report
   Richard I. Gracer, MD, Lawrence Weil, MD, and Neal Frauwirth, MD.

Spinal headache is an occasional, but painful complication of epidural injection procedures due to dural puncture that allows leakage of CSF from the thecal sac, thereby reducing intracranial pressure. In the event of failure of conservative management, (e.g. abdominal binder, fluids, acetaminophen), an epidural blood patch is often used.

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 transforaminal epidural blood patch after the failure of conservative management. The patient underwent left transforaminal epidural injections at L5 and S1 for management of chronic low back pain secondary to post laminectomy syndrome. Three days later, the patient presented with a severe post lumbar puncture headache and failed to respond to conservative management. Interlaminar epidural approach for blood patch was not feasible secondary to prior laminectomy. Transforaminal epidural blood patch was performed utilizing 2 mL of autologous blood at each of the two sites. The patient recovered well without headache.

In cases, with inability to perform interlaminar blood patch, a transforaminal approach may be considered.