•Spinal surgery poses a risk of injury to the dura which can lead to a cerebrospinal fluid (CSF) leak. An occult dural tear may occur whereby the tear and leak are initially undetected.

 

•Patients with a CSF leak can experience signs of meningeal irritation such as neck stiffness, nausea, neurological deficits, and sometimes a subcutaneous fluid collection known as a pseudomeningocele.

 

•Patients can also experience a postural headache which improves with lying down and worsens when sitting up, known as a post-dural puncture headache (PDPH). Most PDPH will self-resolve in 7-10 days with conservative treatment including hydration, caffeine, and bedrest.

 

•For a non-resolving PDPH, surgery may be required to repair the dural tear. Alternatively, an epidural blood patch (EBP) can be considered as a lower risk intervention for symptom control while the dural tear heals. 

 

•An EBP is performed by injecting autologous blood into a patient’s epidural space. The blood in this space is hypothesized to allow the CSF pressure to normalize and symptoms to dissipate.

 

•Performing an EBP can be a helpful procedure to avoid possible complications related to a continued CSF leak such as chronic headache, cranial subdural hematoma, chronic back pain, cerebral venous thrombosis, cranial nerve palsy, and seizures.