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Herpes zoster radiculopathy treated with fluoroscopically-guided selective nerve root injection
Theodore D Conliffe1, Madhuri Dholakia, Zach Broyer
1Rothman Institute of Orthopedics, Philadelphia, PA 19107, USA. TConliffemd@aol.com
Pain Physician
|September 30, 2009
Summary
Herpes zoster radiculopathy, a rare complication of varicella-zoster virus reactivation, can cause significant pain and weakness. Selective nerve root blocks offer a promising treatment option for this condition.
Area of Science:
- Neurology
- Infectious Diseases
- Pain Management
Background:
- Varicella-zoster virus (VZV) is a neurotrophic herpes virus affecting sensory neurons.
- Reactivation causes herpes zoster (shingles), characterized by rash and neuralgic pain.
- VZV reactivation can impact dorsal root ganglia, leading to radiculopathy.
Observation:
- A 75-year-old male presented with a herpetic rash and severe L5 radiculopathy with foot drop.
- Symptoms included burning pain exacerbated by standing/walking.
- MRI and electrodiagnostic studies confirmed L5 radiculopathy, ruling out significant spinal pathology.
Findings:
- Fluoroscopically guided selective nerve root block with Depo-Medrol and Lidocaine provided dramatic pain and weakness relief.
- Following the procedure and physical therapy, the patient regained near-normal function.
- The patient experienced sustained recovery without significant weakness or pain.
Implications:
- Selective nerve root blocks may effectively treat herpes zoster radiculopathy.
- This approach offers a potential solution for this uncommon neurological complication.
- Increased incidence of herpes zoster may lead to more frequent cases of VZV-induced radiculopathy.
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