CT-Guided Epidural Blood Patch for Postoperative Lumbar Cerebrospinal Fluid Leak: A Case Series and Clinical Outcomes

Inadvertent dural injury during lumbar spine surgery is a common complication with reported incidence up to 21%. When inadequately repaired or unrecognized, this can lead to cerebrospinal fluid (CSF) leak and orthostatic headache. Current management strategies include conservative treatment, surgical dural repair, or subarachnoid drain placement. The purpose of this study was to evaluate the technical feasibility and early clinical outcomes of CT-guided epidural blood patch (EBP) as a minimally invasive option for symptomatic postoperative CSF leaks. A retrospective analysis was performed on patients who underwent decompressive lumbar laminectomy at a single academic medical center with subsequent clinical symptoms of CSF leak treated with CT-guided EBP. All patients underwent postoperative lumbar MRI. EBP outcomes were assessed at the immediate periprocedural period, short-term follow-up (≤ 90 days), and long-term follow-up (> 90 days) when available. Nine patients met inclusion criteria and underwent CT-guided EBP. All nine patients (100%) achieved immediate symptomatic relief of positional headaches. Eight of nine patients (88.9%) reported sustained complete resolution at short-term follow-up. One patient had partial improvement only but developed recurrent symptoms 16 days later, ultimately requiring surgical repair. Long-term follow-up data was available for 6 patients, all of whom maintained sustained symptom resolution (median 812 days, range 141-1471 days). No procedural complications were observed. CT-guided EBP demonstrated promising clinical outcomes for the treatment of symptomatic postoperative lumbar CSF leaks in this small retrospective series. This minimally invasive technique represents a potential treatment option for selected patients, complementing existing surgical and conservative approaches.