Epidural blood patch

Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. The procedure can be done blind or under fluoroscopic or CT guidance, and is performed predominantly by radiologists and anaesthetists. 

Indications

• craniospinal hypotension
• post lumbar puncture headache

Contraindications

• allergy to any of the planned medications
• local or systemic infection

Procedure

Epidural blood patches can be targeted (i.e. preprocedural imaging has demonstrated the site of CSF leak) or non-targeted ².

Accessing the spinal epidural space can be done under fluoroscopy or CT, and is essentially identical to one described in the article on lumbar interlaminar epidural injection.

The difference is that the patient has a sterile cannulation prior to, and then the patient's own blood is withdrawn and injected. The volume can be low (2-3 mL) or high (10-20 mL), and can be mixed with contrast to outline the epidural space. 

Complications

Complications include ^3,5:

• transient back pain: most common; pain may last up to 4 weeks ⁶
• radicular pain
• intrathecal haematoma
• spinal subdural haematoma
• cauda equina syndrome
• spinal epidural abscess

Outcomes

The success rate of non-targeted epidural blood patch is variable, reported between 50-95% for craniospinal hypertensionhypotension and 90-99% for post lumbar puncture headache. In successful procedures, the patient's symptoms will objectively improve (some only temporarily), and the imaging features of craniospinal hypotension will reverse ^1,4,5. Sometimes multiple blood patches are required for a successful outcome.