Fluoroscopy-guided caudal epidural blood patch for relieving post-dural puncture headache after lumbar spine surgery

AbstractObjectiveEpidural blood patch is indicated to treat post-dural puncture headache (PDPH). When it was difficult to approach from lumbar area due to surgical wound or scar, we attempted to perform epidural blood patch from caudal hiatus.Case reportA 41-year-old woman had undergone spinal surgery because of L5-S1 spondylolisthesis. After surgery, she complained of posture-related headache and dizziness. Conservative management (fluid-supply, bed rest, and pain control) was attempted, but no improvement. Initially we did lumbar epidural autologous blood patch from the level of L3-4, but in vain. Because the lesion (dural tear) might be located at the level of L5-S1 according to statement of surgeon, we performed caudal epidural autologous blood patch to manage her PDPH under guidance with fluoroscopy. After this treatment, her symptoms dramatically improved.ConclusionsThe results indicated that fluoroscopically guided caudal epidural blood patch could treat lower lumbar epidural tear after spinal surgery