Lebrun Christophe, Peek Dirk, Vanelderen Pascal, Van Zundert Jan
Department of Anesthesiology, Intensive Care, Emergency Care and Pain Therapy, AZ Turnhout, Turnhout, Belgium.
Pain Pract. 2014 Jul;14(6):577-80. doi: 10.1111/papr.12168. Epub 2014 Jan 17.
Cervical radicular pain presents itself as pain radiating from the neck to the arm. If conservative treatment fails, a cervical epidural steroid injection can be considered. A rare but possible complication resulting from the interlaminar approach is unintentional cervical dural puncture that may result in post-dural puncture headache (PDPH). Dural puncture from an interlaminar cervical epidural injection reportedly range from 0.25% to 2.65%. An epidural blood patch is a possible treatment option when conservative treatment fails. Relief could be secondary to 'sealing' of the dural tear from the clotted blood and reestablishment of physiological intracranial pressure. Another theory is an increase in the subarachnoid pressure from the injected blood. The increased pressure may restore normal intracranial pressure. We describe 2 cases of cervical PDPH treated with lumbar epidural blood patch. In 1 case, there was complete resolution of the symptoms and in the other case, there was great improvement of symptoms and a high thoracic blood patch was performed to resolve the remaining headache.
颈神经根性疼痛表现为从颈部向手臂放射的疼痛。如果保守治疗失败，可以考虑进行颈椎硬膜外类固醇注射。经椎间孔入路导致的一种罕见但可能的并发症是意外的颈椎硬膜穿刺，这可能会导致硬膜穿刺后头痛（PDPH）。据报道，经椎间孔颈椎硬膜外注射导致的硬膜穿刺发生率为0.25%至2.65%。当保守治疗失败时，硬膜外血贴是一种可能的治疗选择。缓解可能是由于凝血对硬膜撕裂的“封闭”以及生理颅内压的重建。另一种理论是注入的血液使蛛网膜下腔压力升高。压力升高可能会恢复正常颅内压。我们描述了2例采用腰椎硬膜外血贴治疗的颈椎PDPH病例。1例症状完全缓解，另一例症状有很大改善，并且进行了高位胸椎血贴以解决剩余的头痛。
