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Aninda B. Acharya - One of the best experts on this subject based on the ideXlab platform.
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Varicella Zoster Virus Lumbar Radiculitis: A Case Report (P2.307)
Neurology, 2014Co-Authors: Jazba Soomro, Hesham Allam, Aninda B. AcharyaAbstract:Introduction: Varicella Zoster Virus (VZV) is the etiologic agent of varicella (primary infection) and herpes zoster (reactivation of latent infection). Here we describe an immune competent adult with herpes zoster infection complicated by lumbar Radiculitis with pain and paresthesia. Method: Case Report We present the case of a 39 year old immune competent male with Radiculitis from VZV. He presented with burning lower back pain, paresthesia and hyperesthesia in L3, L4 and L5 dermatomal distribution on the anterior aspect of his thigh and leg. Magnetic resonance imaging of lumbosacral plexus revealed a crescentic shaped peri-articular enhancement adjacent to the right L4-L5 facet joint involving the nerve roots and soft tissue suggestive of inflammation and infections. Three day later he developed an itchy painful vesicular eruption on his lower back in L4-L5 dermatome. Acyclovir and Gabapentin were started. The diagnosis of VZV Radiculitis was made based on the symptom onset, magnetic resonance imaging findings and elevated titers IgM virus in serum. HIV was negative. His symptoms and the rash resolved within 2 weeks. MRI of LS spine after 4 weeks revealed resolution of peri-articular enhancement. There have been a few reported cases of VZV-mediated Radiculitis. VZV radicultis is a rare complication which occasionally occurs in immune compromised individuals. Oral or intravenous anti-viral agents, most commonly Acyclovir, have been used in cases with VZV Radiculitis with complete resolution of symptoms. Conclusion: This case highlights the importance of including a zoster Radiculitis as a differential diagnosis of radicular pain syndromes in immune competent adults. In addition, our case also illustrates the significance of performing imaging to learn about the different patterns of lesions visible with viral Radiculitis. There’s limited literature regarding VZV Radiculitis, the symptoms require proper diagnosis and treatment, and prompt initiation of anti-viral therapy. Disclosure: Dr. Soomro has nothing to disclose. Dr. Allam has nothing to disclose. Dr. Acharya has nothing to disclose.
M Weller - One of the best experts on this subject based on the ideXlab platform.
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hsv 2 sacral Radiculitis elsberg syndrome
Neurology, 2004Co-Authors: Olaf Eberhardt, Wilhelm Kuker, J Dichgans, M WellerAbstract:A self-limiting syndrome of acute urinary retention in combination with variable other signs of spinal cord dysfunction and CSF pleocytosis was described by Elsberg >70 years ago.1 In many instances, a viral etiology is found, and herpes simplex virus type 2 (HSV-2) reactivation from spinal ganglia is the most common associated infection. Lumbosacral involvement in neoplastic disease, as also reported by Elsberg, is rare. The clinical presentation of mostly younger patients with signs of acute radiculomyelitis, such as transient urinary retention and sensory lumbosacral symptoms, is thus referred to as Elsberg syndrome. Sexually active women are preferentially affected, adolescents only rarely. We report a 40-year-old woman who developed sensory loss in a lower sacral dermatome distribution, dull pain in the buttock region, and acute urinary retention. There were no motor symptoms, no obstipation, no fever, and no rash. CSF showed lymphocytic pleocytosis (162/μL) with elevated albumin (690 mg/dL). Serum HSV-2 immunoglobulin (Ig) M and IgG titers …
Kalil G Abdullah - One of the best experts on this subject based on the ideXlab platform.
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adverse events with the use of rhbmp 2 in thoracolumbar and lumbar spine fusions a 9 year institutional analysis
Journal of Spinal Disorders & Techniques, 2015Co-Authors: Daniel Lubelski, Kalil G Abdullah, Michael P Steinmetz, Matthew D Alvin, Amy S Nowacki, Srita Chakka, Edward C BenzelAbstract:STUDY DESIGN Retrospective chart review. OBJECTIVE To describe the adverse outcomes associated with the use of rhBMP-2 in thoracolumbar and lumbar fusions. SUMMARY OF BACKGROUND DATA rhBMP-2 has been increasingly used in spinal fusions over the past decade. Early studies reported that the use of rhBMP-2 is associated with decreased operative time, blood loss, and pain scores, as well as improved fusion rates. Recent investigations have shown rhBMP-2 to be associated with various complications occurring at incidences ranging from 0% to 100%. METHODS Using the institutional electronic medical records, we retrospectively reviewed all patients between January 2002 and September 2010 that underwent thoracolumbar and lumbar spine fusion with BMP. Patient demographics, operative, and outcome/complication information was collected. RESULTS A total of 547 patient charts were reviewed with a mean follow-up time of 17 months. Mean age was 58 years. Forty-one percent of patients had undergone previous spine surgery. Thirty-nine percent of patients had a PLIF/TLIF, 29% underwent a PLF, and 20% an ALIF. No relevant differences in the patient characteristics and complications were identified between the various surgical approaches. For all approaches, having undergone a previous spine surgery was associated with increased incidence of Radiculitis, reoperation, and pseudoarthrosis (P=0.005, 0.0008, 0.05, respectively) as compared with those without previous spine surgery. Being a current smoker at the time of operation was associated with increased rate of Radiculitis (P=0.03) as compared with nonsmokers. CONCLUSIONS The use of rhBMP-2, in this study, had an incidence of Radiculitis, pseudoarthrosis, and reoperation that was similar to the rates in historical controls without rhBMP-2. Complications do not differ by surgical approach, but are more likely in current smokers and those undergoing revision surgery. A prospective study is warranted to further delineate the adverse event profile of rhBMP-2 and the variables that are likely to affect it (ie, type of surgery, carrier, and dose).
Harvinder Singh Chhabra - One of the best experts on this subject based on the ideXlab platform.
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Varicella-Zoster Radiculitis Mimicking Sciatica: A Diagnostic Dilemma.
Asian journal of neurosurgery, 2020Co-Authors: Abhinandan Reddy Mallepally, Rajat Mahajan, Tarush Rustagi, Nandan Marathe, Harvinder Singh ChhabraAbstract: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.
Todd J Albert - One of the best experts on this subject based on the ideXlab platform.
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complications associated with single level transforaminal lumbar interbody fusion
The Spine Journal, 2009Co-Authors: Jeffrey A Rihn, Ravi Patel, Junaid Makda, Joseph Hong, David Greg Anderson, Alexander R Vaccaro, Alan S Hilibrand, Todd J AlbertAbstract:Abstract Background context The transforaminal lumbar interbody fusion (TLIF) procedure has become an increasingly popular means of obtaining a circumferential fusion while avoiding the morbidity of the anterior approach. Concerns remain, however, regarding the clinical efficacy and safety of its use. Purpose The purpose of this study was to evaluate the complications of the single-level TLIF procedure. The difference in complications observed with the use of iliac crest autograft compared with rhBMP-2 will be assessed. Study design Retrospective cohort study; a review of complications. Methods Patients who underwent a single-level TLIF between January 2004 to May 2007 with either autograft iliac crest or rhBMP-2 were identified. A retrospective review of these patients included operative reports, pre- and postoperative medical records, most recent postoperative dynamic and static lumbar radiographs, and computed tomography scans (when available). Results A total of 130 patients met the study criteria; 119 patients were available for follow-up, with an average radiographic follow-up of 19.1 months and an average clinical follow-up of 27.6 months. Thirty-three patients received iliac crest autograft and 86 patients received rhBMP-2. Complications occurred in 40 of the 119 study patients (33.6%). The autograft group had a higher complication rate (45.5% vs. 29.1%), but the difference was not statistically significant (p=.09). Complications in the autograft group included persistent donor-site pain (30.3%), donor-site infection (3.1%), lumbar wound infection (6.1%), and postoperative Radiculitis (3.0%). Complications in the rhBMP-2 group included postoperative Radiculitis (14.0%), vertebral osteolysis (5.8%), ectopic bone formation (2.3%), and lumbar wound infection (3.5%). A hydrogel sealant (Duraseal; Confluent Surgical Inc., Waltham, MA, USA) was used in 37 out of 86 patients in the rhBMP-2 group. The use of this sealant decreased the rate of postoperative Radiculitis in the rhBMP-2 group from 20.4% to 5.4% (p=.047). The radiographic nonunion rate at most recent follow-up was 3.0% in the autograft group and 3.5% (p=.90) in the rhBMP-2 group. Conclusions The most common complications in the autograft group were related to the donor site. The most common complication in the rhBMP-2 group was postoperative Radiculitis, the incidence of which is reduced by the use of a hydrogel sealant.
