Postoperative Shingles Mimicking Recurrent Radiculopathy after Anterior Cervical Diskectomy and Fusion

Varicella-Zoster Radiculitis Mimicking Sciatica: A Diagnostic Dilemma

Varicella-zoster virus (VZV) presenting as a radicular pain in the thoracic region is not uncommon, but the presentation in the lumbar and thigh region is not frequently seen. Characteristic segmental vesicular-bullous rash in a dermatomal distribution associated with pain and allodynia is a prominent feature. The pain appears before rash. It is not uncommon for clinicians to misdiagnose radicular pain caused by VZV due to prolapsed disc. We report two patients who presented to us with complaints of back pain with leg radiculopathy that were initially treated for discogenic radiculopathy and rash was wrongly attributed to hot fomentation. This case report emphasizes the importance of including varicella-zoster radiculitis in the differential diagnosis of radicular pain and clinical examination of every rash. Physical examination is must if the patient complains of rash. Appropriate and timely diagnosis can prevent unnecessary investigations.

Herpes Zoster-Mediated Radiculitis After Lumbar Spine Surgery: A Report on 2 Cases with Differing Outcomes

CASES

Two cases of herpetic neuralgia after lumbar fusion are reported. Although in one case the diagnosis was evident and treatment promptly initiated, the second exhibited a less typical presentation of neuralgia predating the cutaneous rash leading to a misdiagnosis of persistent nerve root stenosis, with additional surgeries and a longer hospital stay.

CONCLUSION

The cases presented highlight why postoperative neuralgia should be approached carefully and systematically investigated. Although rare, postoperative neuralgia may occur as a consequence of postoperative herpes zoster infection. Failure to promptly diagnose this condition may lead to unnecessary surgery that has associated risks and morbidity.

Cervical Radiculopathy Associated With Shingles Herpes Zoster Infection

Objective

This case reports discusses the case of a 43-year-old man with concurrent cervical spine radiculopathy and herpes zoster shingles infection.

Clinical Features

A 43-year-old man with left sided C6 radiculopathy was seen and treated for the clinical diagnosis of C5-C6 disc herniation. Ten days before seeking care he had received influenza and pneumococcal vaccinations. A week after vaccination, he noticed tingling, aching, and fatigue in his left arm. A week later, a rash appeared on his left arm. This was diagnosed via Teladoc as shingles; ibuprofen was prescribed, as too much time had elapsed for antiviral medication.

Intervention and Outcome

Chiropractic spinal manipulation using Cox distraction protocols for a C5-C6 disc herniation was given 5 times over a time period of 5 weeks. This treatment resolved the patient's left arm pain, provided 50% relief for his neck pain, and decreased his left arm rash. Four spinal manipulations were given over the next 12-week period, resulting in 80% reduced neck pain, complete resolution of left arm pain, and faint herpetic rash. The patient stated that he felt he had returned to his level of health before the incident.

Conclusion

Concurrent upper extremity radicular pain accompanied by herpes zoster cutaneous rash is described. Chiropractic spinal manipulation using Cox spinal distraction protocols saw resolution of the patient's complaints. Considered to be an uncommon dual occurrence, radiculopathy and herpes zoster infection deserve clinical discussion and evaluation of treatment protocols.