Post Herpetic Neuropathy of Sinuvertebral Nerve: A Case Report

Abstract

Varicella-Zoster virus is a neurotropic virus of the herpes virus family that primarily affects sensory nerves. Herpes zoster causing sinuvertebral neuropathy has not been mentioned in the literature. A 55 years old man presented with low back pain, both buttocks, posterior thigh and leg pain over last 3 months. A straight leg raising test was positive on both sides. A left great toe dorsiflexion was decreased to 4/5. The VAS score at admission for back and leg pain was 7/10. The patient MRI was showing disc degeneration at L5-S1 level. We performed endoscopic interlaminar annuloplasty using radiofrequency ablation to denervate the sinuvertebral nerve attached to the annulus under epidural anesthesia. Patient symptoms completely relieved at the postoperative period and continued upto recent follow up of 6 months. The classical presentation of the patient after herpes zoster infection as back pain with referred leg pain, disc degeneration on MRI, intraoperative evidence of chronic neuropathy and almost complete improvement in patient symptoms after radiofrequency ablation makes it a first reported case of sinuvertebral neuropathy following herpes zoster infection.