Therapeutic intervention for iatrogenic thoracolumbar pseudomeningocele using ultrasound-guided aspiration and ultrasound-assisted epidural blood patch – A case report

Cerebrospinal fluid (CSF) leakage causing a pseudomeningocele is a well-recognized complication after spine surgery. It presents as a recurrence of low-back pain, radiculopathy, subcutaneous swelling, symptoms of intracranial hypotension, and delayed myelopathy. Definitive surgical repair is needed if not resolved spontaneously or with minimally invasive measures like lumbar subarachnoid drainage and an epidural blood patch (EBP). We report a case of iatrogenic thoracic pseudomeningocele, successfully treated with dual therapeutic intervention (CSF aspiration and EBP) using an ultrasound. This minimally-invasive intervention helped our patient resolve symptoms, avoid radiation, and make it cost-effective by avoiding surgical intervention and polypharmacy of general anesthesia. •Spinal pseudomeningocele results from an extravasated extradural CSF collection from inadvertent meningeal tears.•We successfully treated it with an ultrasound-guided CSF aspiration followed by an ultrasound-assisted EBP application.•It may require surgical exploration and repair upon worsening of symptoms, surgical wound breakdown, and infection.•The CSF diversion and EBP help optimize dural healing by reversing the pressure gradient across the dural defect.•An ultrasound can assess the extent of the extradural CSF leakage/aspiration and confirm the blood injection during EBP.