Discitis Following Transdiscal Approach for Superior Hypogastric Plexus Block

Discitis—the infection of the intervertebral disc space—can result from hematogenous dissemination, direct disc inoculation (either iatrogenic or traumatic), or contiguous spread from an adjacent structure. Unless there is a chronological relationship between symptom onset and recent spine intervention or injury, the diagnosis may be delayed for weeks or months. The initial symptoms are often non-specific (severe back pain, stiffness, occasional fever, and malaise) with evidence of elevated inflammatory markers on work-up. Once discitis is suspected, imaging studies (contrast MRI, PET, or CT scan) should be immediately obtained. Image-guided aspiration biopsy is performed when blood cultures or serologic tests fail to identify the responsible pathogen. Conservative treatment with intravenous antibiotics should be guided by microbiology results. If general or neurologic deterioration occurs, empiric antimicrobial therapy should be initiated and surgery should be considered (Berbari et al., Clin Infect Dis. 61(6):e26–46, 2015).