Plexopathy is a neural disorder causing the damage to a network of nerves, blood vessels or lymph vessels resulting in pain, loss of motor control and sensory deficits. It generally affects the nerves at the brachial and lumbosacral region leading to its two main types;
- Brachial plexopathy
It is also known as brachial plexuses lesion commonly characterized by the injury to the bundle of nerves present in the plexus region.
- Lumbosacral plexopathy
Lumbosacral plexopathy is characterized by the inflammation and damage to the nerve network present in the area of lumbar and sacral vertebrae region in the human body.
This condition is very less common than the brachial plexopathies. Its chances of happening by the trauma are very less as the bundle of the nerves in this region are located deeper in the retroperitoneum region as well as protected by the pelvic brim. Meanwhile diabetic lumbosacral radiculopathy may occur in almost 0.8% of all the patients suffering from diabetes.
Lumbar Plexopathy Symptoms
Some symptoms may include; penetrating or burning pain, numbness and reduced movement in the lower extremities. Considering the common symptoms may involve;
Lumbar Plexopathy Diagnosis
Assessment of the lumbosacral plexopathy is performed by a number of ways including;
A thorough investigation of the patient’s previous medical history and past family history is considered very important in this type of case. Family history of hemophilia, bleeding abnormalities, cancer, radiation exposures, autoimmune diseases, or diabetes mellitus is considered crucial to notice and report.
In this particular case a complete musculoskeletal neurological examination is considered to be the key for diagnosis. It is also important in order to rule out the involvement of upper extremities. For this special tests such as provocative hip maneuvers, gait analysis, balance tests and investigation of clonus and Babinski signs should be counted.
It is to check the abnormality in the routine work such as lower extremities use, gait, transfers and dressing etc.
Lab tests are performed depending upon the suspected etiology. Such as; if diabetic nerve is the suspected etiology then blood glucose and glycosylated hemoglobin levels are performed. Meanwhile in the case of abscess, ESR and white blood count is measured, but in the suspected situation of hematoma, prothrombin time and platelets count is considered crucial to investigate.
Before the introduction of magnetic resonance imaging (MRI), computed tomography (CT) was considered as the most effective and first choice for the diagnosis. And regardless the superiority of the MRI, CT is more readily available and remains the first priority in most of the patients where MRI is contraindicated.
Lumbar Plexopathy Causes
There are a number of reasons for the lumbosacral plexopathy to occur which include;
- Tumors: includes; malignant invasions, metastasis and benign tumors in different regions of the lumbosacral area of body.
- Infection: local organs as well as generalized infections can cause the condition.
- Trauma: including; physical injury, postoperative/stretch injury or childbirth.
- Obstetric related: may include; direct pressure by fetal parts, stretch injuries or rarely forceps applications can also cause the problem.
- Inflammatory/micro vasculitis.
- Vascular lesions.
- Family or individual history of pelvic cancers.
- Individual history of radiations exposure to pelvic region.
Lumbar Plexopathy Treatment
Specialized management of the lumbosacral plexopathy depends upon the causative etiology which leads to the proper treatment of the condition. In this case, pain and functional impairments are counted as the major problems which needs to be managed.
It can be achieved by application of ice/heat modalities, stretching and drug therapy including; NSAIDs, neuropathic agents such as gabapentin, pregabalin, duloxetine, amitriptyline, venlafaxine, or opioids. And in some cases spinal cord stimulators or intrathecal treatments are also recommended.
It is very crucial for improving the quality of life of patients as it allows the strengthening of partially affected muscles as well as helps in reducing muscular imbalance, maintaining flexibility and improvement of gait. For this purpose, assistive devices and braces are recommended to be used at the location where the weakness is exhibited including; anklet-foot orthoses (AFOs). AFOs are placed in the lumbar plexus injuries in order to reduce the dorsiflexion of the foot and to promote knee extension. These are considered crucial especially in the cases of sacral plexopathies as the foot drop is very predominant in this very particular condition.
As the lumbosacral plexus is mostly unfamiliar among the population; therefore, education/knowledge about the symptoms, risk factors and appropriate treatment should be promoted.