Herpes zoster mimicking spinal cord injury after endoscopic spine surgery: A case review

BackgroundHerpes zoster mimicking radiculopathy after spinal surgery has been reported in some studies. But immediate onset of herpes zoster after spinal surgery has not been reported.ObjectiveThis case report aims to increase the awareness of the possible misdiagnosis of herpes zoster as iatrogenic nerve damage because of the occurrence of dermatome pain immediately after surgery.Case descriptionA 41-year-old man presented with a tingling sensation in the lower part of his left trunk and leg and mild gait disturbance. He was diagnosed with T10-11 ossification of the yellow ligament and underwent excision using biportal endoscopy. The operative course was uneventful; however, after waking up from anesthesia, he complained of severe pain and allodynia in his right lower abdomen corresponding to the T10-11-12 dermatome. We suspected spinal cord injury and administered high-dose corticosteroids.ResultsFollow-up MRI showed no significant nerve damage. On postoperative day 5, the patient developed erythematous papules, mainly along the distribution of the T5, T11 root dermatome, which was diagnosed as disseminated zoster.ConclusionHerpes zoster reactivation should be considered in differential diagnosis for new symptoms in a dermatomal distribution after spine surgery in the absence of other suspected iatrogenic causes during surgery.