epidural blood patch

What is an Epidural Blood Patch?

An epidural blood patch is an outpatient procedure done to treat patients with spinal headaches due to leaking spinal fluid.  The cerebrospinal fluid (CSF) is fluid that is in the brain and travels all the way down the spinal cord.

If there is a leak of the CSF, severe headaches can occur as the covering of the brain loses a bit of pressure and is very sensitive to the problem. Thankfully, an epidural blood patch is a minimally invasive procedure that can help seal over the leak and relieve the headaches. A patient’s own blood is removed from an arm and then injected into the area around the spinal leak, sealing over the hole.

Considering that the human CSF is replaced every six hours regularly, once the epidural blood patch seals over the area then the fluid will fill up the brain and spinal cord to its normal pressure soon.

What exactly is a Post Dural Puncture Headache?

A post dural puncture headache is also called a post lumbar puncture headache. There are  a few procedures that involve a puncture of the dura, which is the covering around the spinal cord. One is a myelogram, which is when dye is put into the spinal cord area to look for nerve root compression. Another is a spinal anesthesia used in a surgery or maybe after a lumbar spinal tap diagnostic procedure. The incidence of symptoms after these procedures ranges anywhere from 5 to 30%, so it is not rare (Vilming et al 1998).

There are also procedures which involve placing a needle around the spinal cord, and it is not unusual for there to be an inadvertent puncture of the dura. An example is an epidural  injection for pain management or obstetric use. Usually, these tiny holes seal up by themselves within a few hours.

If they do not, the individual can develop a spinal headache, which is usually severe upon standing up, and relieved substantially while laying down due to less gravity. So if you have had a procedure involving a needle in or around the spinal cord, and are experiencing severe headaches afterwards, that may be the reason.

Coughing, sneezing, straining, or any movement that increases intracranial pressure may intensify the symptoms.

Additional symptoms may include nausea, vomiting, dizziness, or visual disturbances. In unusual circumstances, a patient may develop a subdural hematoma or sustain a seizure. About 80% of patients recover with no treatment within two weeks, however, the other 20% will have symptoms that may continue for months unless treatment is received (Brodsky 1978).

For what conditions is an Epidural Blood Patch effective as a treatment?

Initial treatment of a post dural puncture headache includes bedrest and administration of caffeine. This typically resolves over 80% of symptoms and allows the leak to seal up.

However, if these fail to alleviate symptoms then an epidural blood patch is a very effective next step for a spinal headache after a procedure involving a needle placed on purpose or inadvertently through the spinal cord covering (dura).

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How is the procedure performed?

The first step in an epidural blood patch is simply taking 15-20 mls of blood from a vein. This blood is then used for injection into the area around the spinal leak.

The patient lays on his or her stomach, and the back is sterilized for the injection. A needle is placed with appropriate numbing medicine into the epidural space, and the blood is then injected.