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Transforaminal Cervical Blood Patch for the Treatment of Post–Dural Puncture Headache

Slipman, Curtis W. MD; El Abd, Omar H. MD; Bhargava, Amit MD; DePalma, Michael J. MD; Chin, Kingsley R. MD

American Journal of Physical Medicine & Rehabilitation: January 2005 - Volume 84 - Issue 1 - pp 76-80
Case Report: Injections

Slipman CW, El Abd OH, Bhargava A, DePalma MJ, Chin KR: Transforaminal cervical blood patch for the treatment of post–dural puncture headache. Am J Phys Med Rehabil 2005;84:76–80.

A 40-yr-old woman received a series of three interlaminar epidural steroid injections for the treatment of axial neck pain secondary to degenerative disc disease. Immediately after her third injection, she experienced symptoms of a dural puncture–induced headache. This headache persisted on a daily basis for 3 mos, despite two epidural blood patches using an interlaminar approach, which was finally completely abated with a transforaminal blood patch. The headache was immediately relieved and remained alleviated through the follow-up interval of 1 yr. 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 post–dural puncture headache.

From the Penn Spine Center (CWS, AB, KRC), Department of Rehabilitation Medicine (CWS, AB), and the Penn Orthopaedic Center, Department of Orthopaedic Surgery (KRC), University of Pennsylvania Health System, Philadelphia, Pennsylvania; the Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (OHEA); and the Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University/Medical College of Virginia, Richmond, Virginia (MJDP).

All correspondence and requests for reprints should be addressed to Curtis W. Slipman, MD, The Penn Spine Center, Hospital of the University of Pennsylvania, 3400 Spruce Street, Ground Floor, White Building, Philadelphia, PA 19104.

© 2005 Lippincott Williams & Wilkins, Inc.