Successful transforaminal epidural blood patch in a patient with multilevel spinal fusion

Hanwool Ryan Choi, Benjamin Fuller, Michael Magdy Bottros

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Introduction Epidural blood patch (EBP) is a vital tool in treating postdural puncture headache (PDPH). Traditional interlaminar epidural needle insertion into the epidural space, however, may be challenging due to anatomical variations. As an alternative method, we successfully performed an EBP via transforaminal approach. Case report A mid-50-year-old male patient with multilevel spinal fusion developed PDPH after a failed spinal cord stimulator electrode placement. A transforaminal EBP was carried out by injecting a total of 8 mL of autologous blood into the neuroforamen at the L1-L2 level bilaterally. Our patient's positional headache resolved immediately after the procedure. Discussion To our knowledge, this is the first case reported of a transforaminal EBP in a patient with diffuse epidural adhesive fibrosis secondary to multilevel laminectomies and spinal fusion. This case report highlights potential risks and benefits of this novel technique and also discusses its therapeutic mechanism of action. We believe that a transforaminal EBP should be considered in patients who are poor candidates for the traditional interlaminar EBP.

Original languageEnglish (US)
Pages (from-to)746-749
Number of pages4
JournalRegional Anesthesia and Pain Medicine
Issue number9
StatePublished - Sep 1 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© American Society of Regional Anesthesia & Pain Medicine 2020.


  • back pain
  • injections, spinal
  • pain management
  • post-dural puncture headache


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