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Herpes myelitis after thoracic spine surgery
Mark Daniel Anderson1, Sudhakar Tummala
1Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, USA. mdanderson2@mdanderson.org
Journal of Neurosurgery. Spine
|March 5, 2013
Summary
Herpes reactivation, including herpes simplex and herpes zoster, is a rare but serious complication following spinal surgery. Prompt diagnosis and treatment are crucial for favorable neurological outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Herpes simplex virus (HSV) and herpes zoster virus (HZV) reactivation are uncommon post-spinal surgery complications.
- Literature review from 1980-2012 identified cases of HSV/HZV reactivation after spine surgery.
Observation:
- Reactivation typically presents as a vesicular rash, treatable with acyclovir.
- Disseminated cases can lead to severe neurological conditions like myelitis or encephalitis.
- Atypical presentations without rash can delay diagnosis and treatment, worsening neurological outcomes.
Findings:
- Early recognition of herpes reactivation is vital for timely intervention.
- Focal neurological deficits in a dermatomal pattern post-surgery warrant consideration of HSV/HZV reactivation, even without a rash.
Implications:
- Spine surgeons must consider HSV/HZV reactivation in patients with new neurological symptoms.
- Awareness of atypical presentations can improve diagnostic accuracy and patient management.
- Prompt antiviral treatment is essential to prevent severe neurological sequelae.
