Content area
Full Text
The lumbosacral plexus is situated within the relative protection of the axial skeleton, making blunt trauma a relatively uncommon cause of injury. The most common causes of a lumbosacral plexopathy are usually by direct compression, diabetic neuropathy, complications of pelvic surgery, or parturition. Separating a plexopathy from other neurological effects of other spinal-related problems is often a diagnostic challenge.
Diabetic Plexopathy
Diabetic plexopathy typically affects the lumbosacral plexus more than a brachial. It is distinguished from a peripheral polyneuropathy of long-standing diabetes by its predominantly proximal symptoms. The majority of patients are in their sixth and seventh decade and also have documented distal peripheral polyneuropathy. The most frequent clinical presentation of a diabetic lumbosacral plexopathy is anterior thigh pain, with secondary proximal leg muscle weakness. The muscle weakness is most pronounced in the quadriceps muscles. Sensory loss is generally less pronounced, although patellar reflexes typically are absent or sluggish. With progression, noticeable muscle wasting occurs, resulting in significant atrophy and weight loss. There is a trend for progression from unilateral to bilateral lower-extremity involvement. Diagnosis is therefore based on presentation, presence of diabetes, and the presence of acute electrodiagnostic findings to be discussed later.
Therapy is ultimately focused on the control of the hyperglycemia. Most patients who achieve glucose control typically have significant, but incomplete, recovery of muscle strength. Maximal improvement can require more than one year. After control of the hyperglycemia, rehabilitation strategies address pain management, maintenance of range of motion, and compensatory mechanisms for knee extensor weakness.
Traumatic Plexopathy
Traumatic plexopathy of the lumbosacral plexus typically must be sufficient to produce an unstable, vertical fracture of the pelvic region since the plexus is other-vise well protected from direct impact. Fractures to the sacroiliac joint usually involve the intralateral lumbosacral trunk with impairment clinically seen at the L5 and S1 levels. Fractures or dislocations of the hip joint can produce traction injuries to the lumbosacral plexus. Surgical intervention is imminent and requires initial periods of immobilization post-operatively. The initial lesions can slowly recover during the post-operative rehabilitation.
Hemorrhagic Plexopathy
Hemorrhagic plexopathy is usually caused in the retroperitoneal region, which can compress on the plexus as it passes through either the iliac or psoas muscles. An expanding hematoma within the more laterally located iliopsoas...