Not Every Low Back Pain is a Radiculopathy
Pankaj Bansal MD, CCFP, Laura Grennan, Karthik Mahadevappa, MBBS, MSc, DM, Emilia Semenov MD, Shanker Nesathurai MD,
A 66-year-old man with a history of chronic low back pain and
three previous spine surgical procedures presented with new onset,
acute, excruciating low back pain with dysesthesias radiating to the
left leg, left leg weakness, and difficulty walking. There were no red
flag signs. There was no focal weakness. The left ankle reflex was
diminished. Sensation was decreased on the lateral foot, ankle, and
lower leg. An acute left S1 radiculopathy was suspected. Magnetic
resonance imaging did not reveal any changes from previous.
Three weeks later, a diffuse vesicular rash appeared on his left
leg (Figure 1A, 1B, and 1C) without any changes clinically and it
was complicated by lumbosacral postherpetic neuralgia (PHN).
Over a period of 2.5 months, the patient was treated with oral
acyclovir, tricyclic antidepressants, oxycodone, gabapentin, physical
therapy, and TENS (transcutaneous electrical nerve stimulation).
His pain improved and he eventually returned to full function.
Herpes zoster can manifest as low back pain and dysesthesias,
despite initially suggesting a radiculitis. The most common
neurologic complication is postherpetic neuralgia (abnormal
sensations and severe, intractable pain or allodynia occurring
one month after rash onset).
All persons over 50 years of age and most persons under,
should receive an oral antiviral within 72 hours of rash onset.
Adjunctive corticosteroids do not have any effect on quality of
life or development of PHN.
1. He L, Zhang D, Zhou M, Zhu C. Corticosteroids for preventing postherpetic
neuralgia. Cochrane Database Syst Rev 2008.
Kost R, Srause S. Postherpetic neuralgia. Predicting and preventing risk. Arch
Intern Med1997;157(11):1166–67
About the Authors
Pankaj Bansal MD, CCFP is an Assistant Clinical Professor, Department of Medicine, McMaster University, and Physical Medicine and
Rehabilitation, Hamilton Health Sciences. Laura Grennan is an undergraduate student at McMaster University. Karthik Mahadevappa,
MBBS, MSc, DM is with the Health Services Authority (HSA), Cayman Islands. Emilia Semenov MD is an Attending Physician,
Physical Medicine and Rehabilitation, Whittier Rehabilitation Hospital, Westborough, MA. Shanker Nesathurai MD, MPH, FRCP(C)
is a Professor, Division of Physical Medicine and Rehabilitation, Department of Medicine, and Chief and Division Director, Physical
Medicine and Rehabilitation and Hamilton Health Sciences.
Corresponding Author: Karthik Mahadevappa, MBBS, MSc, DM:
Submitted: May 6, 2018. Accepted: June 10, 2018. Published: February X, 2019. DOI: 10.22374/cjgim.v14i1.284
Figure 1. Images of diffuse vesicular rash
Canadian Journal of General Internal Medicine
16 Volume 14, Issue 1, 2019
Clinical Images