Lumbar Tfesi and potential PDPH

[jwalker12]

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Hey everyone,
I did a L5-S1 and S1 TFESI using a 22g spinal needle on a patient recently. I was never past 6” on the pedicle in AP and contrast appeared epidural. Patient went home later in the day had a mild headache. Subsequently she did fine all day then 36 hours after the procedure developed a headache, bilateral occipital region to crown of the head. Doesn’t endorse postural improvement but I am thinking what if it is a PDPH. How could it have happened if I didn’t go too far into the foremen? It’s just not making sense to me. Thanks for any advice or tips always appreciated.

 

[SSdoc33]

It had been reported after TFESI but ive never seen it. More likely a post steroid reaction. Couple benadryl should be all they need

 

[lobelsteve]

Drug side effect not procedure.

 

[pmrmd]

Its from the dexamethasone.

 

[SommeRiver]

Not a PDPH

 

[soccrwz]

very unlike pdph, likely dex

 

[callmeanesthesia]

Steroid reaction, not PDPH. Not without a strong postural component.

 

[clubdeac]

dex 100%

 

[cbest]

Most likely steroid reaction. Typically resolves in 24-48 hours.


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[jwalker12]

Thanks for the advice. Patient's headache did resolved about 3-4 days later. She responded to the injection as well.