Targeted Epidural Blood Patches Under Fluoroscopic Guidance For Incidental Durotomies Related To Spine Surgeries: A Case Series

Andrew K Wong, Mohammad R Rasouli, Andrew Ng, Dajie Wang

Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, USA

Correspondence: Dajie Wang
Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 3 Crescent Dr. Philadelphia PA, 19112 Philadelphia, PA, USA
Email Dajie.wang@jefferson.edu

Introduction: Incidental durotomies are usually managed conservatively. However, 1.8% of patients require surgical dural repair for CSF leak. There are limited data available regarding the use of epidural blood patches (EBP) for persistent CSF leaks secondary to incidental durotomies. This case series aims to evaluate the efficacy of targeted EBPs under fluoroscopic guidance in the treatment of incidental durotomies.
Methods: Four patients with incidental durotomies after spine surgeries (one cervical decompression, one revision of L5-S1 decompression and fusion, and two lumbar decompressions) were included in this series. These patients did not respond to conservative management and subsequently underwent EBPs. Magnetic resonance imaging (MRI) images were reviewed to confirm and identify the sites of CSF leak prior to the EBPs. We targeted the sites of CSF leak with fluoroscopic guidance. All four patients received an EBP with an 18-gauge epidural needle placed under fluoroscopic guidance. In some cases, epidural catheters were used to further target the sites of CSF leak. Contrast was used to confirm the appropriate placements of the needles and catheters. Approximately 5–14 mL of autologous blood was injected through the needles or catheters to the sites of dural leak.
Results: Three lumbar and two cervical EBPs were performed in four patients (two females and two males). Their age ranged from 44 to 73 years old. Two out of three patients who had lumbar EBP reported complete resolution of symptoms following EBP. The patient who had cervical epidural patches did not have improvement in her symptoms.
Conclusion: This case series demonstrated that targeted EBP can be an effective treatment for CSF leak from incidental durotomies. However, dural tears in the cervical region may be more difficult to treat. Larger scale studies are required to evaluate efficacy of EBP in the treatment of symptomatic incidental durotomies.

Keywords: durotomy, spine surgery, headache, epidural blood patch, CSF leak