Discoblock-Associated Subarachnoid Hemorrhage: A Case Report

TL;DR

A rare case of subarachnoid hemorrhage following a discoblock procedure is reported, highlighting a potential but uncommon complication.

Contribution

This is the first reported case of subarachnoid hemorrhage associated with a discoblock procedure.

Findings

Subarachnoid hemorrhage occurred 9 hours after a discoblock procedure.

MRI showed hyperintensities in the left temporoparietal sulci and left ambient cistern.

The case highlights the need for increased awareness of rare complications of discoblock.

Abstract

The discoblock procedure entails the administration of an anesthetic agent during discography to pinpoint the origin of spinal pain in challenging diagnostic scenarios. Known for its minimal complication rate, the most frequently documented adverse effect is discitis. This case report introduces a novel observation of subarachnoid hemorrhage following a discoblock procedure. Initially presenting with persistent lower back pain, the patient exhibited dehydrated lumbar discs on imaging, characterized by altered T2 signal intensity and a diffuse disc bulge impacting the anterior thecal sac at the L4-5 level, alongside degenerative scoliosis at L2-3. These findings suggested the potential origins of symptoms at L4-5 or L2-3, leading to the decision to proceed with L4-5 discoblock. Symptom alleviation postdiscoblock, coupled with prophylactic cefazolin administration, indicated the necessity for further management at the L4-5 disc level. Subsequently, the patient presented with status epilepticus 9 hours later, with brain magnetic resonance imaging revealing anomalous hyperintensities in the left temporoparietal sulci and the left ambient cistern, prompting suspicion of subarachnoid hemorrhage. This study elucidates the procedural indications for discoblock, explores potential factors contributing to complications, and delves into the safety considerations surrounding this intervention.

Figures