by David Borenstein, MD Executive EditorTheSpineCommunity.com12/2020
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.
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- Ke D et al. Herpes zoster in patients with sciatica. BMC Musculoskeletal Disorders. https://doi.org/10.1186/s12891-020-03847-5
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