DELAYED BACKACHE AFTER SPINAL-ANESTHESIA

A 50-year-old man had an inguinal hernia repair under spinal anaesthes ia with bupivacaine. On the 2nd postoperative day, he complained of ba ckache and paresis at the posterior part of the lower extremities, wel l relieved by non-steroidal anti-inflammatory drugs. On the 6th postop erative day, he came back to hospital, because of low back pain associ ated with a heavy feet sensation. The hypothesis of a neurological com plication of the spinal anaesthesia was considered. The interview of t he patient revealed a history of lumbar disk disease, not reported dur ing the preoperative visit. After an in depth clinical examination, tw o causes seemed possible: subarachnoid haematoma and lumbar disk protu sion. Against the first diagnosis were the initial clinical signs. How ever, in many cases, objective neurological deficit arise too late to allow efficient neurosurgical treatment. Thus, a MRI examination was p erformed which is non invasive in comparison with a computed tomograph y myelogram. In our patient, it did not detect a true lumbar disk prot usion, but a simple degenerative disease of the L5-S1 disk. In suppres sing the lumbar lordosis, spinal anaesthesia probably allowed a disten sion of spinal capsules and tendons, responsible for the troubles.