Herpes zoster (Shingles) in patients with sciatica
by David Borenstein, MD Executive Editor TheSpineCommunity.com 12/2020
Sciatica is a condition associated with pain in the sciatic nerve radiating down a leg. Sciatica is caused most commonly by intervertebral disc herniation. The herniated disc compresses a spinal nerve that causes a painful, burning sensation in the leg. A concern that has been proposed is that the irritation of a spinal nerve can cause the reappearance of varicella-zoster, chickenpox virus, in that specific nerve. The activation of the virus causes a blistering rash to appear in the distribution of the nerve. In about 10% of these patients, a persistent pain may remain with the irritation of the nerve, post-herpetic neuralgia.
A question has been raised about relationship of developing sciatica and the increased risk of developing herpes zoster (HZ). A study from China was undertaken to determine if there was an increased risk. The investigators looked at individuals who had sciatica between 2000 and 2012 and age-matched controls.
In total, 49,023 patients with sciatica and 49,023 matched controls. Females had sciatica about 7% more commonly. Patients with sciatica had a 20% greater chance of developing HZ. HZ risk was significantly higher in patients aged 50-64 years, and patients aged > 65 years, than those aged <49 years. Co-morbidities like obesity, cancer, diabetes does not necessarily increase the risk of developing HZ compared to disc herniation.
The study suggests that HZ should be prevented in patients with sciatica. Individuals who are over 50 years of age should consider obtaining HZ vaccine to prevent the appearance of HZ and post-herpetic neuralgia.
Ke D et al. Herpes zoster in patients with sciatica. BMC Musculoskeletal Disorders. https://doi.org/10.1186/s12891-020-03847-5
Herpes zoster in patients with sciatica
Several diseases are associated with herpes zoster (HZ). However, whether sciatica is a stressor leading to HZ development remains unclear. Here, we evaluated the occurrence of HZ in patients with sciatica. The sciatica cohort consisted of patients first diagnosed as having sciatica between 2000 and 2012. All patients with sciatica were randomly age, sex and index year matched with control individuals without sciatica. The primary outcome was diagnosis of HZ. All individuals were followed until HZ diagnosis, withdrawal from the insurance, death, or December 31, 2013, whichever occurred first. HZ risk in the two cohorts was further analyzed with age, sex and comorbidity stratification. In total, 49,023 patients with sciatica and 49,023 matched controls were included. Female patients were more likely to have HZ development than were male patients [adjusted hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.02–1.12]. After adjustments for all the covariates, HZ risk was significantly higher in the sciatica cohort than in the control cohort (adjusted HR = 1.19; 95% CI = 1.12–1.25). Sciatica increased HZ risk. Thus, HZ risk should be addressed whenever physicians encounter patients with sciatica, HZ vaccination should be considered especially those aged over 50.