Background:TOH is a rare but severe disease which affects mostly men;it’s more frequent in females in late stage of pregnancy.Symptoms are acute pain or fracture of the hip(s).It can evolve to avascular femur necrosis with similar radiologic features(altered bone marrow density and vascular deficit).Promptly recognized it can be successfully treated relieving pain,allowing physical activity and reducing complications(1,2).Pelvic Girdle Pain(PGP)is pain between posterior iliac crest and gluteal fold,strictly related to musculoskeletal system;it needs specific management and multidisciplinary evaluation.Its prevalence in pregnancy is 70-85%.Etiology is unclear and multifactorial(3).

Case Report:A 40-years old nulliparous woman underwent cesarean section(CS) at 40 weeks of gestation for breech-vertex presentation.She complained of right and anterior thigh and inguinal pain since 6 weeks.She rated pain 6/10 on the Numeric Rating Scale.Past medical history was silent,she never suffered for PGP.Due to pain and impaired physical activity she consulted her gynecologist who imputed symptoms to uterine enlargement and fetal pressure on obturator nerve and prescribed no therapy.The day of CS she received uncomplicated subarachnoid anesthesia(SA) at L3-L4 level;she referred a total benefit concerning to hip pain,but 3 hours later she complained of pain on both hips.Anesthesiologists were sigled out.We excluded potential arms of SA and asked for X-ray.Image showed at both femur heads two area of subcortical damage with irregular margins.Then MRI identified bone marrow edema on right greater than left femoral head and neck as sign of bilateral TOH.

Discussion:First:pain wasn’t in obturator territory;femoral roots,which appeared to be involved,don’t descend in the true pelvis,making compression injury unlikely.Second:SA is a safe procedure for CS,although not free from risks.Peripheral neuropathies can occur but their incidence is very low.They are due to trauma by needles.Because of body habitus changes in pregnancy SA for CS should be done below L3 and gently(4).In our case SA had no complications so we didn’t found any case/effect relationship.

01 / PELVIC PAIN AFTER SPINAL ANESTHESIA FOR CESAREAN SECTION. A MISDIAGNOSED CASE OF TRANSIENT OSTEOPOROSIS OF THE HIP (TOH)