BACKGROUND: Patients with connective tissue disorders (CTDs), such as Ehlers-Danlos syndrome, can present unique challenges in the management of spinal pathology and procedural complications due to underlying tissue fragility and susceptibility to dural ruptures. Thus, there is a need for less invasive diagnostic and therapeutic care in this population.

CASE REPORT: We present a case of a 48-year-old woman with joint hypermobility who developed acute-on-chronic back pain and radicular symptoms. Imaging revealed an L5-S1 radiculopathy and a thoracic arachnoid cyst. During inpatient rehabilitation, she experienced a postdural puncture headache (PDPH) following a thoracic spine myelogram refractory to conservative measures and the gold standard, epidural blood patches (EBPs), necessitating the need for management strategies tailored to her complex clinical profile.

DISCUSSION: Managing PDPH in patients with CTDs requires careful consideration of alternative therapeutic options and potential complications associated with standard treatments like EBPs.

CONCLUSIONS: This case highlights the need for individualized approaches to minimize procedural risks while optimizing patient outcomes in this population.

KEYWORDS: Ehlers-Danlos syndrome, Joint hypermobility syndrome, epidural blood patch, postdural puncture headache, thoracic arachnoid cyst