Topic:

Bacterial infections

Abstract No.:

ISE.204

Title:

Uncommon complication of spinal anaesthesia: acute discitis

Author(s):

S. Koirala¹, B. Bhattarai², A. Ghimire³; ¹B.P.Koirala Institute of Health Sciences, Anaesthesiology and Critical Care, Dharan, SUNSARI/NP, ²B. P. Koirala Institute of Health Sciences, Anesthesiology and Critical Care, Dharan, KOSHI/NP, ³B.P.Koirala Institute of Health Sciences, Anaesthesiology and Critical Care, Dharan/NP

Abstract:

Background: Discitis most commonly develops as a rare complication of bacterial infection or chemical or mechanical irritation during spine surgery with a postoperative incidence of 1%–2.8%. It is also a complication of discography. Although it is controversial whether discitis can be caused by an aseptic or infectious process, recent data suggest that persistent discitis is almost always bacterial. Very few cases of discitis associated with pregnancy and spinal anesthesia have been reported. The best diagnostic measure may be magnetic resonance imaging (MRI) in our setting. The mainstay for discitis treatment is pain control and antibiotics; surgical intervention is usually not required. Complications of discitis include intervertebral fusion, epidural abscess and paralysis.
Methods: 22 years female presented in the emergency room with complains of severe low back pain for one day. She underwent lower segment caesarean section in a zonal hospital. Under strict aseptic precaution subarachnoid block was given at L2-L3 level. There was no complication during the procedure and the surgery was carried out and a healthy baby was delivered. On examination the vitals were stable and there was tenderness in the lumbar spine where the subarachnoid block was given. Diagnosis of post spinal backache was made. MRI was planned to confirm the diagnosis of acute discitis.
Results: For next two weeks the patient was asymptomatic when she developed sudden onset of low back pain without any precipitating cause. The pain radiated towards the knee. Pain was migratory in character and has aggravated since one day.
Conclusion: Even in the absence of neurological deficits, one should consider the possibility of discitis in a patient with worsening low back pain who does not respond to conservative treatment after spinal anesthesia.