Blood patch
After a lumbar puncture and sometimes spontaneously, patients can develop a leak of their spinal fluid into the surrounding tissues.
These leaks decrease the pressure in the spinal fluid and thus around the spine and head resulting in postural headaches. A postural headache is severe in the upright position and improved in the recumbent position. If conservative therapy (rest, caffeine, analgesics) fails, a blood patch can be used to treat the condition. A blood patch delivers blood to the space around the spinal sac and either primarily covers the leak and/or increases the pressure enough to stop the leak of fluid and allow the repair process to occur. This procedure, which takes 15-30 minutes, is highly effective.
Pre-procedure instructions
An NMH nurse will contact you prior to your procedure date to discuss the following:- Confirm your appointment date and time
- Inform you of your arrival time and parking instructions
- Prior imaging: please bring any prior spine imaging including film, CD and reports. Prior imaging includes CT, MRI and X-Ray.
- Current medications, especially blood thinners
- Allergies
- Your questions
Hospital arrival
Arrive on-time or better yet, early. If you are driving from a distance or inclement weather is forecasted, please leave extra time for your trip. When you arrive, come to the 4th floor of the Feinberg Pavilion and “check-in” at the desk. You are now in the “waiting room”. Shortly after check-in, a support staff will take you to the “holding room”. In the holding room, you will meet a holding room nurse who will perform a pre-procedure check-list and help you change into a hospital gown. A physician will then meet with you to discuss your procedure, answer your questions and obtain informed consent.
Team and Quality
Quality, safety and precision guide our practice. Each procedure is staffed by a nurse, a radiology technologist and a staff physician. The nurse is responsible for monitoring your vital signs, providing procedural medications, making you comfortable and supporting the physician. The procedure technologist is responsible for positioning you on the procedure table, obtaining the appropriate instruments, documenting the procedure with imaging and assisting the physician. The staff physician is responsible for knowing your history, performing the procedure and providing you with follow-up instructions.
Procedure
You are brought to the procedure room by the nurse, transferred to the procedure table and sterilely prepped and draped. Before proceeding, a pre-procedure “Time-out” to confirm your identity, the planned procedure and any relevant details such as allergies is performed. This is strictly for your safety. Using sterile technique, universal precautions and local anesthetic, a thin needle is advanced through the skin to the target tissues. In the case of a post-spinal tap postural headache, the target level is the level of puncture. Spontaneous leaks require a more complex procedure with multiple target levels. The target tissues are precisely localized by advancing the needle under image guidance (fluoroscopic or CT) and confirmed with a test injection of dye. When the needle is in the appropriate position(s), blood is withdrawn from the patient and injected. The needle is removed, skin cleaned and a standard band-aid applied.
Post-procedure
You are monitored in the holding room for 1 hour: the vast majority of patients are discharged at 1 hour. You may have immediate relief of your headache but sometimes it takes a few days for your spinal fluid to regenerate and for you to return to normal. The key to the post-procedure instructions is that anything that increases your intrabdominal pressure increase pressure in your spinal sac possibly preventing healing. Any strategy to avoid coughing, sneezing, laughing and straining is recommended. Caffeinated fluids also are helpful.
Follow-up
The vast majority of patients with a post LP (post spinal tap) headache are cured from a single blood patch. A small percent have a second blood patch, which is typically curative. Patients with headache related to spontaneous intracranial hypotension are more complex and may require multiple sessions at multiple levels.
Potential side effects
If too much blood is injected, the patient can experience a headache from too much pressure. This headache resolves within a few hours. Patients with pre-existing degenerative disease in their spine can have an exacerbation of symptoms such as increased back pain and leg pain. These symptoms also typically resolve within a few hours.