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Postoperative Shingles Mimicking Recurrent Radiculopathy after Anterior Cervical Diskectomy and Fusion.

Montgomery JT, Lawrence BD, Brodke DS, Patel AA - Global Spine J (2015)

Bottom Line: The study required no outside funding.The study authors have no financial interest in any of the products or techniques discussed.The patient, however, developed postherpetic neuralgia and remained symptomatic at her 2-year postoperative visit.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, United States.

ABSTRACT
Study Design Case report and review of literature. Objective To report the case of a 67-year-old woman who developed delayed onset (6 months) of symptomatic shingles after cervical nerve root decompression in a previously symptomatic dermatome. Methods The patient's clinic course and outcomes were retrospectively reviewed. The study required no outside funding. The study authors have no financial interest in any of the products or techniques discussed. Results The patient received definitive treatment for shingles once the zoster form rash manifested. The patient, however, developed postherpetic neuralgia and remained symptomatic at her 2-year postoperative visit. Conclusions Although shingles is a common disease state affecting patients in the fifth and sixth decades of life, it is rarely seen in the setting of cervical nerve root decompression. This case demonstrates the need to include shingles on the differential diagnosis of recurrent neurogenic pain after anterior cervical decompression and fusion.

No MeSH data available.


Related in: MedlinePlus

T2-weighted sagittal magnetic resonance imaging performed 6 months postoperatively after patient presented with recurrent symptoms. Note that no persistent and/or recurrent stenosis apparent at the C5–C6, C6–C7 level.
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FI1400012cr-4: T2-weighted sagittal magnetic resonance imaging performed 6 months postoperatively after patient presented with recurrent symptoms. Note that no persistent and/or recurrent stenosis apparent at the C5–C6, C6–C7 level.

Mentions: At her 6-month evaluation, the patient presented stating that 3 weeks earlier, she began experiencing a severe exacerbation of radicular symptoms in her left upper extremity. Upon examination her symptoms were consistent with a left C6 radiculopathy. Repeat cervical radiographs and cervical MRI (Fig. 4, Fig. 5) failed to demonstrate recurrent stenosis or pseudarthrosis and showed no evidence of adjacent-level changes. An electromyography test (EMG) was ordered and the patient was scheduled for further follow-up exams. Shortly after this examination, the patient developed an erythematous vesicular rash extending from the left shoulder to the first and second digits (Fig. 6, Fig. 7) and the EMG was not performed due to the presence of this pathognomonic rash. She was diagnosed with herpes zoster (HZ) in a left C6 nerve root distribution. She was started on valacyclovir and topical steroids, and she reported progressive reduction in symptoms.


Postoperative Shingles Mimicking Recurrent Radiculopathy after Anterior Cervical Diskectomy and Fusion.

Montgomery JT, Lawrence BD, Brodke DS, Patel AA - Global Spine J (2015)

T2-weighted sagittal magnetic resonance imaging performed 6 months postoperatively after patient presented with recurrent symptoms. Note that no persistent and/or recurrent stenosis apparent at the C5–C6, C6–C7 level.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4472289&req=5

FI1400012cr-4: T2-weighted sagittal magnetic resonance imaging performed 6 months postoperatively after patient presented with recurrent symptoms. Note that no persistent and/or recurrent stenosis apparent at the C5–C6, C6–C7 level.
Mentions: At her 6-month evaluation, the patient presented stating that 3 weeks earlier, she began experiencing a severe exacerbation of radicular symptoms in her left upper extremity. Upon examination her symptoms were consistent with a left C6 radiculopathy. Repeat cervical radiographs and cervical MRI (Fig. 4, Fig. 5) failed to demonstrate recurrent stenosis or pseudarthrosis and showed no evidence of adjacent-level changes. An electromyography test (EMG) was ordered and the patient was scheduled for further follow-up exams. Shortly after this examination, the patient developed an erythematous vesicular rash extending from the left shoulder to the first and second digits (Fig. 6, Fig. 7) and the EMG was not performed due to the presence of this pathognomonic rash. She was diagnosed with herpes zoster (HZ) in a left C6 nerve root distribution. She was started on valacyclovir and topical steroids, and she reported progressive reduction in symptoms.

Bottom Line: The study required no outside funding.The study authors have no financial interest in any of the products or techniques discussed.The patient, however, developed postherpetic neuralgia and remained symptomatic at her 2-year postoperative visit.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, United States.

ABSTRACT
Study Design Case report and review of literature. Objective To report the case of a 67-year-old woman who developed delayed onset (6 months) of symptomatic shingles after cervical nerve root decompression in a previously symptomatic dermatome. Methods The patient's clinic course and outcomes were retrospectively reviewed. The study required no outside funding. The study authors have no financial interest in any of the products or techniques discussed. Results The patient received definitive treatment for shingles once the zoster form rash manifested. The patient, however, developed postherpetic neuralgia and remained symptomatic at her 2-year postoperative visit. Conclusions Although shingles is a common disease state affecting patients in the fifth and sixth decades of life, it is rarely seen in the setting of cervical nerve root decompression. This case demonstrates the need to include shingles on the differential diagnosis of recurrent neurogenic pain after anterior cervical decompression and fusion.

No MeSH data available.


Related in: MedlinePlus