Lumbosacral spondylodiscitis following superior hypogastric nerve block performed during uterine artery embolization: a case report

BACKGROUND: Uterine artery embolization (UAE) is a minimally invasive, uterus-preserving treatment for symptomatic uterine fibroids with a low infection rate, and post-procedural infections are typically confined to the pelvis. Extra-pelvic deep infections are exceptionally rare. We describe an unusual delayed presentation of lumbosacral spondylodiscitis following an otherwise uncomplicated UAE. CASE PRESENTATION: A 30-year-old woman with symptomatic uterine fibroids underwent bilateral UAE. Embolization was performed with 700-900 μm microspheres to angiographic stasis, with adjunct superior hypogastric nerve block (SHNB) for analgesia via an anterior suprapubic approach. Recovery was initially uneventful; however, new low back pain developed approximately 1 week post-procedure. At day 20, inflammatory markers were mildly elevated with a normal white blood cell count, and lumbar magnetic resonance imaging (MRI) demonstrated no abnormality. Despite conservative management, pain progressively worsened with functional limitation. Repeat MRI at 7 weeks revealed L5-S1 spondylodiscitis. After antibiotic therapy, follow-up MRI at 11 weeks demonstrated progression with abscess formation, prompting referral to neurosurgery for further management. CONCLUSION: Persistent or progressive back pain after UAE, particularly when inflammatory markers rise, warrants reassessment and consideration of spondylodiscitis. Early MRI may be normal; repeat MRI is appropriate when symptoms persist or worsen. This case highlights spondylodiscitis as a rare but serious complication in the procedural setting, with SHNB representing a possible contributory mechanism.