[A case of vertebral metastasis revealed by incomplete spinal analgesia for cesarean section]

A 36-year-old woman was scheduled for Cesarean section under spinal anesthesia. She was a carrier of hepatitis-B-virus and diabetic. She was complaining of low back pain. Spinal anesthesia was performed in the left lateral decubitus position. Because lumbar puncture in the midline was difficult, left paramedian approach was tried. Then she began to complain of right leg pain. Another attempt was made at other site, but her pain was not relieved. After confirming drop of blood-tinged cerebrospinal fluid, 0.3% dibucaine 2.0 ml was injected. Sensory anesthesia was assessed by pin-prick, but anesthesia was not effective. Then epidural catheter was inserted at Th12-L1 using median approach. She received 1.0% lidocaine 15 ml. However, sensory anesthesia was insufficient (Th4-Th12). Therefore O2-N2O was administered in addition to regional anesthesia. After the delivery, she still complained of low back pain. Later examination revealed metastatic bone tumor of L2 from hepatoma. This case suggests that in a patient with such incomplete spinal or epidural anesthesia and neurological finding, vertebral metastatic tumor should be ruled out.