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Case Reports in Neurological Medicine
Volume 2019, Article ID 1968314, 4 pages
https://doi.org/10.1155/2019/1968314
Case Report

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

1Department of Anesthesiology and Pain Medicine, Bucheon ST. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon 14647, Republic of Korea
2Department of Anesthesiology and Pain Medicine, Saint Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea

Correspondence should be addressed to Yoo Jung Park; rk.ca.cilohtac@jyp

Received 31 January 2019; Accepted 26 May 2019; Published 19 June 2019

Academic Editor: Shahid Nimjee

Copyright © 2019 Yu Na Choi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.