PMC6792944_01
Lumbar spine MRI demonstrating epidural fluid collection and development of pseudomeningocele. CSF leak at right L4 laminectomy site marked by the arrows. Left: sagittal view, Right: axial view.
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Her magnetic resonance imaging (MRI) of the lumbar spine revealed a large pseudomeningocele at L4-5 (Figure 1). Prior to the EBP, we reviewed the MRIsand confirmed the presence of a large CSF leak at the left L4-5 laminectomy site (Figure 1).
Fluoroscopic image of the spine during the blood patch. Arrow in the image mark the contrast spread reached the targeted epidural space at left L4-5 level.
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The epidural space was accessed at L5-S1 interlaminar space (Figure 2).
PMC6792944_02
MRI of the lumbar spine showed a fluid collection in the posterior paraspinal and subcutaneous soft tissue at L5 level, which was consistent with a large pseudomeningocele as marked by the arrows. Left: sagittal view, Right: axial view.
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MRI of lumbar spine showed a fluid collection in the posterior paraspinal and subcutaneous soft tissue at L5 level, which was consistent with a large pseudomeningocele (Figure 3).
Fluoroscopic image of the spine during the blood patch. Arrows in the images mark the contrast spread in the epidural space. Image on the left depicts the AP view while image on the right depicts lateral view.
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Contrast was injected and visualized the epidural space at the L5-S1 level (Figure 4).
Repeat MRI of the lumbar spine after four months showed marked resolution of the fluid collection in the posterior paraspinal and subcutaneous soft tissue at L5 level as marked by the arrows. Left: sagittal view, Right: axial view.
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A repeat MRI of lumbar spine four months later showed marked improvement of the pseudomeningocele. (Figure 5) At a four-month follow-up, this patient remained headache free.
PMC6792944_03
Cervical spine MRI sagittal view revealed epidural fluid collection in cervical and upper thoracic spine as marked by the arrow.
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Her cervical spine MRI scan revealed an epidural fluid collection in the cervical and upper thoracic regions (Figure 6).
Fluoroscopic image of the spine during the epidural blood patch. Arrow in the image marks the site of needle entry at C7-T1 interlaminar space and the tip of epidural catheter at left side C6 level.
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Subsequently, 4 mL of autologous venous blood was injected through the catheter (Figure 7).
PMC6792944_04
MRI of the lumbar spine showed a large CSF collection at L4-5 level extending from the spinal canal into the laminectomy bed, paravertebral regions, and subcutaneous tissues. The site of CSF leak was marked by the arrow. Left: sagittal view, Right: axial view.
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His lumbar spine MRI revealed a large CSF collection at L4-5 level extending from the spinal canal into the laminectomy bed, paravertebral regions and subcutaneous tissues (Figure 8).