title: Cervical epidural blood patch--A literature review.
abstract: OBJECTIVE
  Epidural blood patches (EBP) are rarely performed at the cervical levels, primarily due to fear of neurological complications such as spinal cord compression. We reviewed the literature to provide an evidence-based review of performance of cervical EBPs, with a specific focus on indication, technique, safety, and efficacy.
  
  
  METHODS
  A comprehensive electronic literature search was done to include studies that reported on performance of cervical EBPs in patients with CSF leak at the cervical level. Data regarding indication, level of CSF leak, level of cervical EBP, volume of blood used, efficacy, and complications were collected.
  
  
  RESULTS
  A total of 15 studies, reporting on 19 patients were included. All patients presented with a headache that increased in the standing position, and improved in the supine position. All patients were identified to have a CSF leak at the cervical level. Eight patients first underwent a lumbar EBP, without complete, long-term relief. All these patients, along with 11 patients who did not undergo a lumbar EPB prior to cervical EBP, reported complete, long-term pain relief. EBPs were mostly done in the prone position, using imaging guidance. An average of 5-8 mL of autologous blood was injected in the epidural space. No major neurological complications were reported in any patient.
  
  
  CONCLUSIONS
  The review suggests that cervical EBP can be performed for cervical CSF leaks associated with positional headache without a significant risk of serious adverse events.
  
  
  METHODS
  Our review provides Class II level of evidence that cervical EBPs are safe and effective in reliving positional headache due to CSF leak.
authors.affiliation: Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA.
authors.forename: Shruti G
authors.initials: SG
authors.lastname: Kapoor
authors.affiliation: Department of anethesia, critical care and pain medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Shihab
authors.initials: S
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural / Q000706:statistics & numerical data*; D015984:Causality; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology* / Q000628:therapy*; D002574:Cervical Vertebrae; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D006261:Headache / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D018570:Risk Assessment; D013129:Spinal Puncture / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cervical; Epidural Blood Patch; Headache