lumbar plexopathy

Post-herpetic lumbar plexopathy (post-herpetic segmental paresis), immune-mediated lumbar plexopathy and diabetic radiculoplexopathy (diabetic amyotrophy) have similar and seemingly parallel semiologies. The latter two conditions have an underlying microvasculitic pathological substrate that has shown potential (yet unproven) amelioration with immunodulatory therapy. These observations gave us the motivation to treat our patient with intravenous methylprednisolone for a profound proximal left leg weakness due to post-herpetic segmental paresis...

Herpes zoster is a frequent cause of neuralgia and dermatomal vesicular rash secondary to reactivation of latent varicella zoster virus. However, it rarely presents with acute lumbar radiculopathy and the diagnosis can be quite challenging in such cases. Nerve signal abnormalities on magnetic resonance imaging are well recognized in herpes zoster neuropathy or plexopathy affecting the extremities, although gadolinium enhancement is characteristically absent. In this article, we describe a case of acute herpes zoster lumbosacral radiculopathy with characteristic vesicular dermatomal rash and second ever reported finding of gadolinium enhancement of the lumbar nerve on magnetic resonance imaging...

Background: Peripheral neuropathy is a common complication of Lyme disease. Cranial mononeuropathy, particularly that affecting the facial nerve, can be a presenting symptom, and at times, it can be associated with polyradiculopathies or plexopathies. However, isolated femoral neuropathy has not yet been reported in Lyme disease; therefore, we felt the need to present this case. Case presentation: Laboratory investigations were performed on a 67-year-old man living in a region at high risk for Lyme disease after he developed erythema migrans on his chest, accompanied by the swelling of his left knee joint...

BACKGROUND: Lateral interbody fusion (LIF) is an effective adjuvant for circumferential minimally invasive surgery (CMIS) treatment of adult spinal deformity (ASD). Accessing L5-S1 via an oblique LIF (OLIF) approach (OLIF 5-1) allows for anterior LIF (ALIF) at the lumbosacral junction without repositioning the patient. We review the early outcomes and complications of OLIF 5-1 at the bottom of a long construct for an MIS approach to treat ASD. METHODS: We queried a prospectively collected registry of 111 consecutive patients with ASD (Cobb angle >20°, sagittal vertical alignment [SVA] >50, or pelvic incidence [PI]-lumbar lordosis [LL] mismatch>10) patients who underwent CMIS correction between January 2015 and January 2019...

BACKGROUND: The unique anatomy and biomechanical features of the cervical spine and sacrum may impact treatment outcomes following spine stereotactic body radiotherapy (SBRT). Current data for spine metastases are not specific for these locations. OBJECTIVE: To report imaging-based SBRT outcomes to cervical and sacral metastases. METHODS: We retrospectively reviewed our prospective spine SBRT database for cervical and sacral metastases. Patients were followed at 2- to 3-mo intervals with a clinical visit and full spine magnetic resonance imaging (MRI) and we report overall survival (OS), vertebral compression fracture (VCF), and MR imaging-based local control (LC) rates...

Various pathologic conditions extending from the lumbar and pelvic regions to the lower leg may manifest as foot drop, or weakness of ankle dorsiflexion. Potential causes of foot drop include L5 radiculopathy, lumbosacral plexopathy, sciatic neuropathy, and peroneal neuropathy. Although the first-line test in lesion localization is most commonly electrodiagnostic testing, MR neurography has emerged as a useful tool to verify lesion site, to accurately characterize the cause of the neuropathy, and to guide patient treatment...

BACKGROUND CONTEXT: Intraoperative neurophysiological monitoring (IONM) has gained rather widespread acceptance as a method to mitigate risk to the lumbar plexus during lateral lumbar interbody fusion (LLIF) surgery. The most common approach to IONM involves using only electromyography (EMG) monitoring, and the rate of postoperative deficit remains unacceptably high. Other test modalities, such as transcranial electric motor-evoked potentials (tcMEPs) and somatosensory-evoked potentials, may be more suitable for monitoring neural integrity, but they have not been widely adopted during LLIF...

We describe the unique case of a 51-year-old lady who developed a contralateral lumbosacral plexopathy two days after a lumbar microdiscectomy. This is the first report to date of this complication occurring following this procedure. We review the literature regarding lumbosacral plexopathy and discuss the evidence base behind investigating and managing this condition and the potential pathophysiological mechanisms which underlie its development. We draw comparisons with the more widely recognised post-operative brachial neuritis, characterised by delayed onset brachial plexopathy developing after cervical decompression, and propose an immune-mediated inflammatory mechanism linking the two conditions...

Injury to the lumbosacral (LS) plexus is a well-described complication after lateral retroperitoneal transpsoas approaches to the spine. The prognosis for functional recovery after lumbosacral plexopathy or femoral/obturator neuropathy is unclear. We designed a retrospective case-control study with patients undergoing one-level lateral retroperitoneal transpsoas lumbar interbody fusion (LLIF) between January 2011 and June 2016 to correlate electrodiagnostic assessments (EDX) to physiologic concepts of nerve injury and reinnervation, and attempt to build a timeline for patient evaluation and recovery...

MRI without and with contrast is the most accurate imaging method to determine whether a process is intrinsic or extrinsic to a nerve of the brachial or lumbosacral plexus. However, there are no Current Procedural Terminology codes to correspond to imaging studies of the brachial or lumbar plexus discretely. This assessment uses "MRI of the brachial plexus" or "MRI of the lumbosacral plexus" as independent entities given that imaging acquisition for the respective plexus differs in sequences and planes compared with those of a routine neck, chest, spine, or pelvic MRI, yet acknowledges the potential variability of ordering practices across institutions...

Metastasis of breast cancer is often detected through a long-term course and difficult to diagnose. We report a case of brachial plexopathy suspected to be the initial lesion of breast cancer metastasis, which was only detected by magnetic resonance (MR) neurography. A 61-year-old woman was admitted to our hospital within 2 years after operation for breast cancer because of progressive dysesthesia and motor weakness initially in the upper limb on the affected side and subsequently on the contralateral side...

Spinal stenosis and low-grade spondylolisthesis produce symptoms of neural compression that can be treated with extreme lateral lumbar interbody fusion (XLIF) via indirect decompression. This study aimed to investigate whether the restoration of disc dimensions would relieve symptoms of radiculopathy, claudication and back pain. In this retrospective study, patients undergoing XLIF surgery for relief of radicular symptoms or degenerative disc disease were included. Radiologically proven changes were used to assess the modes of degeneration...

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INTRODUCTION: Minimally invasive oblique lateral interbody fusion (OLIF) has steadily gained popularity as the fusion method of choice in patients with spondylolisthesis or foraminal stenosis. However, the complication rates reported in the literature vary greatly between authors. In this research, the authors report the clinical outcomes and perioperative complications of OLIF at L4-5. METHODS: The authors retrospectively reviewed prospectively acquired records of patients with L4-5 spondylolisthesis or foraminal stenosis who had undergone OLIF between 2013 and 2015...

BACKGROUND: In the lumbar spine, do more nerve root injuries occur utilizing minimally invasive surgery (MIS) techniques versus open lumbar procedures? To answer this question, we compared the frequency of nerve root injuries for multiple open versus MIS operations including diskectomy, laminectomy with/without fusion addressing degenerative disc disease, stenosis, and/or degenerative spondylolisthesis. METHODS: Several of Desai et al. large Spine Patient Outcomes Research Trial studies showed the frequency for nerve root injury following an open diskectomy ranged from 0...

Identifying extra spinal causes of a lumbar radiculopathy or polyneuropathy can be a tricky diagnosis challenge, especially in children. Among them, traumatic or iatrogenic pseudoaneurysms of iliac arteries have been seldom reported, in adults' series. The authors report an unusual case of progressive paralyzing left sciatica and lumbar plexopathy in a 12 years old boy, 12 months after a pelvic osteotomy for bilateral hip luxation secondary to osteochondritis dissecans. Spine MRI and pelvic CT angiography revealed a giant internal iliac artery pseudoaneurysm, enclosed in a chronic hematoma...

Radiculopathy triggered by degenerative spinal disease is the most common cause of spinal surgery, and the number of affected elderly patients is increasing. Radiating pain that is extraspinal in origin may distract from the surgical decision on how to treat a neurological presentation in the lower extremities. A 54-year-old man with sciatica visited our outpatient clinic. He had undergone laminectomy and discectomy to treat spinal stenosis at another hospital, but his pain remained. Finally, he was diagnosed with a plexopathy caused by late recurrence of colorectal cancer, which compressed the lumbar plexus in the presacral area...

Patients frequently suffer from lumbosacral plexus disorder. When conducting a neurological examination, it is essential to assess the extent of muscle paresis, sensory disorder distribution, pain occurrence, and blocked spine. An electromyography (EMG) can confirm axonal lesions and their severity and extent, root affliction (including dorsal branches), and disorders of motor and sensory fiber conduction. Imaging examination, particularly gadolinium magnetic resonance imaging (MRI) examination, ensues. Cerebrospinal fluid examination is of diagnostic importance with radiculopathy, neuroinfections, and for evidence of immunoglobulin synthesis...

Postoperative radiculopathy has previously been reported as a common complication of transforaminal lumbar interbody fusion (TLIF). However, no data has been published on lumbar plexopathy following TLIF. We present a rare case of lumbar plexopathy occurring following TLIF (L5-S1) in a patient with spondylolisthesis. Although initially a diagnostic challenge, sinister causes of neuropathy such as bleeding or neoplastic growths were excluded by imaging. A diagnosis of acute lumbar plexopathy of left L2 to L4 was eventually made after electromyographic studies was performed in consultation with a senior neurologist...