Resolution of brachioradial pruritus following anterior cervical discectomy and fusion: a case report

Abstract

Background: Brachioradial pruritus (BRP) is a rare, chronic condition that typically presents in middle-aged light-skinned females as itching of the dorsolateral upper extremities in the C5-C6 dermatome distribution. Cervical nerve compression and ultraviolet (UV) radiation are largely considered to be causative factors. There have been very few case reports where surgical decompression was used to treat BRP. This case report is unique because our patient had a brief period of symptom recurrence 2 months post-operation as supported by displacement of the cage on imaging. The patient then underwent implant removal and revision with the use of an anterior plate leading to complete symptom resolution.

Case description: A 72-year-old female presenting with a 2-year history of severe, persistent pruritus and mild pain of bilateral arms and forearms. The patient was being followed by her dermatologic providers for 10+ years for other unrelated diagnoses. She was referred to our office after having trialed multiple topical medications, oral medications, and injections without lasting definitive success. Cervical spine radiographs demonstrated severe degenerative disc disease with osteophyte formation at C5-C6. Cervical magnetic resonance imaging (MRI) revealed disc herniation at C5-C6 causing mild cord compression with bilateral foraminal stenosis. Patient proceeded with anterior cervical discectomy and fusion at C5-C6, which provided immediate symptom relief. Two months post-operation, her symptoms recurred and repeat cervical spine radiographs revealed cage migration. The patient underwent a revision of fusion by removal of the cage and placement of an anterior plate. At her most recent 2-year follow-up visit, she has been doing well post-operatively without any pain or pruritus.

Conclusions: This case report illustrates the use of surgical intervention as a viable treatment option for specific patients with persistent BRP that have failed all other forms of conservative management. Cervical radiculopathy should be included in the differential diagnosis until ruled out by advanced imaging, particularly in cases of BRP that are refractory to standard dermatological treatment.

Keywords: Brachioradial pruritus (BRP); case report; cervical neuropathy; spinal fusion; ultraviolet radiation.

Figure 1

Preoperative radiographic lateral view of the cervical spine showing severe disc degeneration at C5-C6 and collapse of the disc space.

Figure 2

Preoperative MRI revealing disc herniation at C5-C6 causing mild cord compression with bilateral foraminal stenosis. MRI, magnetic resonance imaging.

Figure 3

Initial ACDF 12-week postoperative radiographic anteroposterior view of the cervical spine showing migration of the surgical cage implant to the right. Patient reported return of mild symptoms at her 6- and 12-week postoperative appointments. ACDF, anterior cervical discectomy and fusion.

Figure 4

Initial ACDF 12-week postoperative radiographic lateral view of the cervical spine showing collapse of the surgical cage implant. Patient reported return of mild symptoms at her 6- and 12-week postoperative appointments. ACDF, anterior cervical discectomy and fusion.

Figure 5

Revision ACDF 2-week postoperative radiographic anteroposterior view of the cervical spine demonstrating well-aligned surgical implant without evidence of migration. Patient reported immediate resolution of symptoms following revision ACDF. ACDF, anterior cervical discectomy and fusion.

Figure 6

Revision ACDF 2-week postoperative radiographic lateral view of the cervical spine demonstrating well-aligned surgical implant without evidence of migration. Patient reported immediate resolution of symptoms following revision ACDF. ACDF, anterior cervical discectomy and fusion.

Figure 7

Revision ACDF 24-month postoperative radiographic anteroposterior view of the cervical spine demonstrating well-aligned surgical implant without evidence of migration. Patient reported no return of symptoms during the 24-month postoperative period. ACDF, anterior cervical discectomy and fusion.

Figure 8

Revision ACDF 24-month postoperative radiographic lateral view of the cervical spine demonstrating well-aligned surgical implant without evidence of migration. Patient reported no return of symptoms during the 24-month postoperative period. ACDF, anterior cervical discectomy and fusion.