A case of acute discitis following spinal anesthesia: a rarity or a tip of the iceberg?
Acute discitis, an inflammatory process of the intervertebral disc, has been reported as a rare complication of bacterial infection or chemical or mechanical irritation most commonly following spinal surgery. It may extend into the adjacent tissue and lead to grave orthopaedic and neurological consequences. Although it has been reported as an infective complication following spinal anesthesia also, its true incidence in our part of the world is not known. It may be higher than generally thought as the technique is overwhelmingly used. Further, we do not know about its awareness among anesthesia practitioners. Here we report a case of acute discitis in a young lady who presented with severe acute low back pain two weeks after spinal anesthesia for caesarean section; magnetic resonance imaging of lumbosacral spine revealed infective spondilodiscitis and she was treated with antibiotics and analgesics. The true incidence of acute infective discitis following spinal anaesthesia in our part of the world is unknown and it may be higher that thought. It can be prevented by using rigorous aseptic techniques, and anesthesia should be administered by appropriately qualified and trained personnel.
Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine 2009;34(10):1066-77. https://doi.org/10.1097/BRS.0b013e3181a1390d [PMid:19363457]
Fraser RD, Osti OL, Vernon-Roberts B. Discitis after discography. J Bone Joint Surg Br 1987;69:26-35. [PMid:3818728]
Ha KY, Kim YH. Chronic inflammatory granuloma mimics clinical manifestation of lumbar spinal stenosis after acupuncture: a case report. Spine (Phila Pa 1976) 2003;28:E217-20. https://doi.org/10.1097/01.BRS.0000067278.67428.40 [PMid:12782998]
Bajwa ZH, Ho C, Grush A, Kleefield J, Warfield CA. Discitis associated with pregnancy and anaesthesia. Anesth Analg 2002;94:415-16. [PMid:11812710]
Chaudhary P, Shrestha BP, Khanal GP, Maharjan R, Paneru SR, Yadav DK. Discitis after spinal anaesthesia in lower limb surgery in orthopaedics. Health Renaissance 2012;10:150-2. https://doi.org/10.3126/hren.v10i2.6587
Saeed MU, Gottmukkula R, Kennedy DJ. Group G Streptococcus spinal epidural abscess: a case report and review of the literature. Scand J Infect Dis 2007;39:1073-5. https://doi.org/10.1080/00365540701477576 [PMid:17852916]
Hopkinson N, Stevenson J, Benjamin S. A case ascertainment study of septic discitis: clinical, microbiological and radiological features. QJM 2001;94:465-70. https://doi.org/10.1093/qjmed/94.9.465 [PMid:11528009]
Khan IA, Vaccaro AR, Zlotolow DA. Management of vertebral diskitis and osteomyelitis. Orthopedics 1999;22:758-65. [PMid:10465488]
- There are currently no refbacks.
Copyright (c) 2017 Siddhartha Koirala, Suraj Lamichhane, Navin Karn
This work is licensed under a Creative Commons Attribution 4.0 International License.
Journal of Society of Anesthesiologists of Nepal (JSAN)
ISSN: 2362-1281 (Print) eISSN: 2467-9119 (Online)