• Hanwool Ryan Choi, Benjamin Fuller, and Michael Magdy Bottros.
• Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA hchoi22@wustl.edu.
• Reg Anesth Pain Med. 2020 Sep 1; 45 (9): 746-749.

IntroductionEpidural blood patch (EBP) is a vital tool in treating postdural puncture headache (PDPH). Traditional interlaminar epidural needle insertion into the epidural space, however, may be challenging due to anatomical variations. As an alternative method, we successfully performed an EBP via transforaminal approach.Case ReportA mid-50-year-old male patient with multilevel spinal fusion developed PDPH after a failed spinal cord stimulator electrode placement. A transforaminal EBP was carried out by injecting a total of 8 mL of autologous blood into the neuroforamen at the L1-L2 level bilaterally. Our patient's positional headache resolved immediately after the procedure.DiscussionTo our knowledge, this is the first case reported of a transforaminal EBP in a patient with diffuse epidural adhesive fibrosis secondary to multilevel laminectomies and spinal fusion. This case report highlights potential risks and benefits of this novel technique and also discusses its therapeutic mechanism of action. We believe that a transforaminal EBP should be considered in patients who are poor candidates for the traditional interlaminar EBP.© American Society of Regional Anesthesia & Pain Medicine 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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