Nguyen Brandon, McGuire Rylee, Taylor James
Midwestern University Arizona College of Osteopathic Medicine, Glendale, AZ, USA.
Kansas City University Graduate Medical Education Consortium (KCU-GME Consortium)/HCA Healthcare Kansas City Program, Kansas City, MO, USA.
J Spine Surg. 2023 Jun 30;9(2):195-200. doi: 10.21037/jss-22-90. Epub 2023 Apr 10.
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.
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.
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.
肱桡部瘙痒症（BRP）是一种罕见的慢性疾病，通常发生于中年浅肤色女性，表现为C5 - C6皮节分布区域的上肢背外侧瘙痒。颈椎神经受压和紫外线（UV）辐射在很大程度上被认为是致病因素。很少有病例报告使用手术减压来治疗BRP。本病例报告具有独特性，因为我们的患者在术后2个月出现了短暂的症状复发，影像学检查显示椎间融合器移位。患者随后接受了植入物取出并使用前路钢板进行翻修，症状完全缓解。
一名72岁女性，有2年双侧手臂和前臂严重、持续性瘙痒及轻度疼痛的病史。该患者因其他无关诊断被皮肤科医生随访10多年。在试用多种外用药物、口服药物和注射治疗均未取得持久明确疗效后，她被转诊至我们科室。颈椎X线片显示严重的椎间盘退变疾病，C5 - C6有骨赘形成。颈椎磁共振成像（MRI）显示C5 - C6椎间盘突出，导致轻度脊髓受压和双侧椎间孔狭窄。患者接受了C5 - C6前路颈椎间盘切除融合术，症状立即缓解。术后2个月，症状复发，复查颈椎X线片显示椎间融合器移位。患者接受了翻修手术，取出椎间融合器并放置了前路钢板。在最近的2年随访中，她术后恢复良好，无任何疼痛或瘙痒症状。
本病例报告说明了手术干预对于特定的持续性BRP患者是一种可行的治疗选择，这些患者在所有其他形式的保守治疗均失败。在通过先进影像学排除之前，颈椎神经根病应列入鉴别诊断，特别是在对标准皮肤科治疗难治的BRP病例中。
