Targeted Transforaminal Epidural Blood Patch for Postdural Puncture Headache in Patients with Postlaminectomy Syndrome

Abstract

Postdural puncture headache is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. If conservative treatments are not successful, the epidural blood patch is the gold standard of the treatment for dural puncture. The interlaminar approach is the most commonly used technique for an epidural blood patch. This case report describes a patient who was treated with a transforaminal epidural blood patch for postdural puncture headache following an acupuncture procedure on his lower back after two epidural blood patches using an interlaminar approach had failed. The patient underwent an acupuncture therapy for management of chronic low back pain due to postlaminectomy syndrome. After the procedure, the patient had a severe headache and the conservative treatment was not effective. The two interlaminar epidural blood patches at the L2–3 level and at the L3–4 level were failed. We performed transforaminal epidural blood patch at the L3–4 and L4–5 levels on the left side, the site of leakage in the MRI myelogram. His symptoms finally subsided without complication. This case demonstrates that targeted transforaminal epidural blood patch is a therapeutic option for the treatment of postdural puncture headache when epidural blood patch using an interlaminar approach is ineffective.

Sphenopalatine Ganglion Block versus Conservative Management for Post Dural Puncture Headache in Cesarean Section

“…3 The first response to PDPH in the clinical practice is conservative management which fails to show prompt result and it may take up to 7-10 days. However, The gold standard treatment for PDPH is an autologous epidural blood patch (AEBP), 4,5 which has its own set of advantages and disadvantages. 6,7 The SPGB is simple, easy and can be done at bedside or the out-patient department.…”

鍼灸安全性関連文献レビュー2016～2019年

“…その内訳は、感染19件 40-58) 、臓器損傷12件 59-70) 、神 経損傷7件 [71][72][73][74][75][76][77] 、皮膚疾患4件 [78][79][80][81] 、折鍼・伏鍼・異 物8件 [82][83][84][85][86][87][88][89] 、その他1件 90) 、灸による事象0件であっ た。論文の筆頭著者の所属国・地域は18あり、そ の内訳は、 韓国 (13文献) 44,45,52,57,58, [76][77][78]80,82,83,85,90) 、 ア メリカ (7) 40,46,55,68,79,84,88) 、中国(6) 50,56,63,65,87,89) 、イギリ (2) 49,64) 、カナダ (2) 51,86) 、マレーシア (2) 61,66) 、オラ ンダ (1) 42) 、デンマーク (1) 48) 、ニュージーランド (1) 53) 、台湾 (1) 67) 、イラン (1) 71) 、イタリア (1) 72) 、 アイルランド (1) 73) 、スイス (1) 81) であった。なお、 文献69と文献78は出版の前年にWeb上で公開され たため、表2-2ではWeb上の発表年で分類・記載 している。 (1)感染 細菌感染が19文献19症例 40-58) であった。内訳は、 膿瘍が12文献12症例 40,41,43,44,46,…”