Expert: Ronald Levy, M.D. - 6/18/2008

Question
I had a myelogram that resulted in a severe spinal headache with dizziness and nausea.  It has now been slightly over one month that I have had these symptoms.  I did have a blood patch on the third day of it's onset, and experienced only one day of relief before my symptoms came back.  I had been improving slightly over the past month, but had a significant relapse in severity of symptoms when I tried to ride in a car to leave the house.

I have been researching the sucess rates of blood patches and have refrained from a second due to the discouraging results of the information I was finding on the internet.  I was committed to waiting this out and letting it heal on it's own, but am now seriously considering a second patch as I cannot seem to find relief.  I am still concerned about the high percentages of these patches that are not successful.  I have found some information on the internet about CT guided blood patches.  Do you know if these are more accurate or more successful than those typically performed by anasthesiologists without CT guidance?  If so, do I have an option to ask for CT guidance?  THANK YOU for time and expertise.

Mindi


Answer
While repeat patches have a lower success rate, it is still better than not having it and the risks of having it are less then not having it. I have never heard of a CT guided patch. It seems to be to be impossible to do because you'd have to keep moving the patient in and out fo the CT to reposition the needle. I have heard of Fluoroscopically guided placement. I don't think the success rate would be any better however. You are either in the correct space or not, so unless they had a hard time getting into the epidural space, I don't see an advantage.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston