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Unintentional Cervical Dural Tap Treated with Lumbar Blood Patch
Author(s) -
Lebrun Christophe,
Peek Dirk,
Vanelderen Pascal,
Van Zundert Jan
Publication year - 2014
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12168
Subject(s) - medicine , epidural blood patch , surgery , lumbar , anesthesia , epidural steroid injection , lumbar puncture , neck pain , complication , blood pressure , intracranial pressure , intracranial hypotension , low back pain , cerebrospinal fluid , radiology , magnetic resonance imaging , alternative medicine , pathology
Cervical radicular pain presents itself as pain radiating from the neck to the arm. If conservative treatment fails, a cervical epidural steroid injection can be considered. A rare but possible complication resulting from the interlaminar approach is unintentional cervical dural puncture that may result in post‐dural puncture headache ( PDPH ). Dural puncture from an interlaminar cervical epidural injection reportedly range from 0.25% to 2.65%. An epidural blood patch is a possible treatment option when conservative treatment fails. Relief could be secondary to ‘sealing’ of the dural tear from the clotted blood and reestablishment of physiological intracranial pressure. Another theory is an increase in the subarachnoid pressure from the injected blood. The increased pressure may restore normal intracranial pressure. We describe 2 cases of cervical PDPH treated with lumbar epidural blood patch. In 1 case, there was complete resolution of the symptoms and in the other case, there was great improvement of symptoms and a high thoracic blood patch was performed to resolve the remaining headache.