Temporary Spinal Cord Stimulation for Herpes Zoster With Myelitis: A Case Series

Abstract

Introduction: Preventing the development of postherpetic neuralgia (PHN), the most prevalent and severe complication of herpes zoster (HZ), is vital. Recently, it has been suggested that using temporary spinal cord stimulation (tSCS) for 10-14 days can improve HZ-associated pain (ZAP) and prevent PHN. However, myelitis complicates HZ. Permanent SCS has been successful in treating neuropathic pain induced by postoperative transverse myelitis of the spine that has not responded to traditional multidisciplinary treatment. However, it is unknown whether tSCS can reduce ZAP complicated with myelitis. Methodology: Between January 2020 and April 2022, all patients with HZ who visited our pain clinic with spinal cord edema and who underwent tSCS were enrolled in this study; their medical records were retrospectively examined. Pain intensity was assessed at baseline (before initiating interventional procedures), just before tSCS, after tSCS removal, and one and three months after tSCS. Results: Twelve patients were enrolled. The mean Numerical Rating Scale (NRS) was 7.9 ± 1.6 at baseline (before interventional procedures), 6.8 ± 2.2 before tSCS (after interventional procedures), and 3.5 ± 2.4 after tSCS. Compared with before tSCS, the mean NRS decreased to 3.3 ± 2.3 after tSCS (P = 0.0004). The mean NRS changes with interventional procedures before and after tSCS were -1.2 ± 2.2 (P = 0.0945) and 3.3 ± 2.3 (P = 0.0004), respectively; the change after tSCS was significantly higher (between-group difference: -2.1 ± 3.7; P = 0.0324). Conclusions: Temporary SCS alleviated pain in cases of shingles with myelitis refractory to interventional therapy. Even in cases with myelitis, tSCS for ZAP remains an effective way to prevent PHN.

Keywords: herpes zoster; myelitis; postherpetic neuralgia; spinal cord stimulation; zoster-associated pain.

Figure 1. Change in NRS from baseline.

^*Significantly lower than NRS before tSCS (P < 0.05). NRS, Numerical Rating Scale; tSCS, temporary spinal cord stimulation

Figure 2. Change in myelitis of case 2.

Arrows indicate unilateral edema in case 2. (A) Before tSCS: one month after HZ onset; (B) thinning: 19 months after HZ onset; (C) disappeared: 30 months after HZ onset. The high-signal region within the spinal cord is gradually thinning. tSCS, temporary spinal cord stimulation; HZ, herpes zoster

Figure 3. MRI image of edema.

(A) Arrows indicate a bilateral edema in case 1; (B) arrows indicate an edema of the anterior horn of the spinal cord in case 9. MRI, magnetic resonance imaging