Chronic Back Pain Secondary to a Calcified Epidural Blood Patch

Willner, Dafna; Weissman, Charles; Shamir, Merav H.

doi:10.1097/aln.0b013e31816499b7

Cited by 15 publications

(9 citation statements)

References 17 publications

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“…EBP is the gold standard treatment at present but is an invasive method that can cause serious complications such as early and late back pain, radiculopathy, spinal‐subdural hematoma, spinal‐epiarachnoid hematoma, intrathecal hematoma, arachnoiditis, infection, and permanent neurological sequalae 12,13 . Willner et al 14 have recently reported a case of calcified spinal epidural hematoma following EBP after a dural puncture that developed radiculopathy but was relieved of his symptoms with surgical neural foraminotomy. A lack of success in up 70% of the cases has also been reported when it is performed in the first 24 hours following the headache 15 .…”

Section: Discussionmentioning

confidence: 99%

Treatment of Post‐Dural Puncture Headache With Bilateral Greater Occipital Nerve Block

Takmaz¹,

Kantekin²,

Kaymak³

et al. 2010

Headache

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(Headache 2010;50:869-881) Epidural blood patch is an effective treatment with a low complication rate. It is also an invasive method that can cause permanent neurological sequelae such as early and late back pain, radiculopathy, spinal-subdural hematoma, spinal-epiarachnoid hematoma, intrathecal hematoma, arachnoiditis, and infection. We report a case in which a postdural puncture headache resolved within 2 minutes of a greater occipital nerve block, a minimally invasive and easy procedure with a low complication rate. This case report suggests that a greater occipital nerve block may be a successful alternative treatment for patients with post-dural puncture headache.

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Section: Discussionmentioning

confidence: 99%

Treatment of Post‐Dural Puncture Headache With Bilateral Greater Occipital Nerve Block

Takmaz¹,

Kantekin²,

Kaymak³

et al. 2010

Headache

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“…Back pain has been reported to linger for a mean of 4 weeks (range 3–100 days) in as many as 16% of patients 29. Chronic back pain was reported due to calcified EBP hematoma 30…”

Section: Where To Inject?mentioning

confidence: 99%

Epidural blood patch is an iatrogenic epidural hematoma: asymptomatic or symptomatic? This is the question

Narouze

2019

Reg Anesth Pain Med

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“…Additionally, rare complications including spinal subdural hematoma, spinal subdural epiarachnoid hematoma, intrathecal hematoma, chronic back pain secondary to a calcified epidural blood patch, and arachnoiditis are noted in the literature. Neurologic deterioration secondary to increased intracranial pressure following EBP has also been cited (21)(22)(23)(24)(25)(26)(27). Delayed radicular pain has not yet been noted as a complication to EBP.…”

Section: Wwwpainphysicianjournalcommentioning

confidence: 99%

Delayed Radicular Pain Following Two Large Volume Epidural Blood Patches for Post-Lumbar Puncture Headache: A Case Report

Desai

Dave²,

Martín³

2010

Pain Phys

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Introduction: Postdural puncture headache (PDPH) is a known complication of diagnostic lumbar puncture. Multiple factors including needle size, type, and needle bevel orientation, have been postulated to contribute to the development of PDPH. The presentation of PDPH tends to have classic symptoms that include a postural headache, nausea, vomiting, tinnitus, and ocular disturbances. Conservative treatment measures include bed rest, intravenous hydration or caffeine, and analgesics. Resistant cases might require an epidural blood patch (EBP). Though complications are rare, cases of immediate post-procedural pain and subdural epidural hematoma have been reported. Here we present a case of PDPH treated with sequential EBPs that resulted in delayed radicular pain. Case Report: A 29-year-old female presented to the emergency room with a severe frontal headache of several days duration. She underwent a diagnostic lumbar puncture as a part of her work-up. Then, 24-48 hours later she developed a severe postural headache unresponsive to conservative care. Two days later she underwent an epidural blood patch with 20 mL of autologous blood. Her symptoms did not abate, prompting a repeat EBP within 24 hours with an additional 20 mL of autologous blood. Five days later the patient began experiencing muscle spasms and radicular pain in the buttocks and left posterior leg that radiated to her posterior calf. The patient was initially started on pregabalin 25mg 3 times daily, and underwent a gadonlinum-enhanced MRI of the lumbar spine. She followed up 5 days later with unchanged symptoms and a negative MRI. She was then started on a methylprednisolone taper and continued the pregabalin. At the 10-day follow-up, there was 90% resolution of symptoms and a pain intensity of 1/10 on NRS. At this time she is continuing the pregabalin with plans to discontinue medication. Discussion: Although EBP is typically a safe procedure, complications might occur. An inflammatory response, secondary to the injection of blood, or mechanical compression, due to the total volume of blood injection, are highlighted as possible causative agents in the development of this complication. The role of fluoroscopic imaging, particularly in patients who have failed an initial EBP, must also be examined. Given the rates of false loss of resistance (17- 30%) reported in the literature, the use of real-time imaging to ensure proper needle placement and subsequent injectate spread should be considered. Key words: Blood patch, epidural, radiculopathy, postdural puncture headache, complications, fluoroscopy, epidural

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Chronic Back Pain Secondary to a Calcified Epidural Blood Patch

Cited by 15 publications

References 17 publications

Treatment of Post‐Dural Puncture Headache With Bilateral Greater Occipital Nerve Block

Treatment of Post‐Dural Puncture Headache With Bilateral Greater Occipital Nerve Block

Epidural blood patch is an iatrogenic epidural hematoma: asymptomatic or symptomatic? This is the question

Delayed Radicular Pain Following Two Large Volume Epidural Blood Patches for Post-Lumbar Puncture Headache: A Case Report

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