Lumbosacral Plexopathies

  • Seward B. Rutkove
  • Tracy W. Sax


Lumbosacral plexopathies are relatively uncommon and may present a diagnostic challenge. They may be difficult to distinguish from the more prevalent lumbosacral radiculopathies. Also, nonstructural lesions, such as idiopathic lumbosacral plexitis or diabetic amyotrophy, are usually diagnoses of exclusion. This chapter discusses the various causes and management of lumbosacral plexopathies.


Lumbosacral plexopathy diabetic amyotrophy lumbosacral plexitis radiation plexitis psoas hematoma gluteal compartment syndrome 


  1. 1.
    Hollinshead WH. Anatomy for surgeons, vol. 3: the back and limbs. New York: Harper & Row; 1969.Google Scholar
  2. 2.
    Eisen A. The electrodiagnosis of plexopathies. In: Brown WF, Bolton CF, editors. Clinical electromyography. 2nd ed. Boston: Butterworth-Heinemann; 1993. p. 211–25.Google Scholar
  3. 3.
    Taylor BV, Kimmel DW, Krecke KN, Cascino TL. Magnetic resonance imaging in cancer-related lumbosacral plexopathy. Mayo Clin Proc. 1997;72:823–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Ishii K, Tamaoka A, Shoji S. MRI of idiopathic lumbosacral ­plexopathy. Neurology. 2004;63:E6.PubMedCrossRefGoogle Scholar
  5. 5.
    Aveline C, Bonnet F. Delayed retroperitoneal haematoma after failed lumbar plexus block. Br J Anaesth. 2004;93:589–91.PubMedCrossRefGoogle Scholar
  6. 6.
    Kaymak B, Ozçakar L, Cetin A, Erol O, Akoğlu H. Bilateral lumbosacral plexopathy after femoral vein dialysis: synopsis of a case. Joint Bone Spine. 2004;71:347–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Chiu WS. The syndrome of retroperitoneal hemorrhage and lumbar plexus neuropathy during anticoagulant therapy. South Med J. 1976;69:595–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Emery S, Ochoa J. Lumbar plexus neuropathy resulting from retroperitoneal hemorrhage. Muscle Nerve. 1978;1:330–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Merrick HW, Zeiss J, Woldenberg LS. Percutaneous decompression for femoral neuropathy secondary to heparin-induced retroperitoneal hematoma: case report and review of the literature. Am Surg. 1991;57:706–11.PubMedGoogle Scholar
  10. 10.
    Jaeckle KA. Neurologic manifestations of neoplastic and radiation-induced plexopathies. Semin Neurol. 2010;30:254–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Thomas JE, Cascino TL, Earle JD. Differential diagnosis between radiation and tumor plexopathy of the pelvis. Neurology. 1985;35:1–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Hébert-Blouin MN, Amrami KK, Myers RP, Hanna AS, Spinner RJ. Adenocarcinoma of the prostate involving the lumbosacral plexus: MRI evidence to support direct perineural spread. Acta Neurochir (Wien). 2010;152:1567–76.CrossRefGoogle Scholar
  13. 13.
    Alsever JD. Lumbosacral plexopathy after gynecologic surgery: case report and review of the literature. Am J Obstet Gynecol. 1996;174:1769–77.PubMedCrossRefGoogle Scholar
  14. 14.
    Feasby TE, Burton SR, Hahn AF. Obstetrical lumbosacral plexus injury. Muscle Nerve. 1992;15:937–40.PubMedCrossRefGoogle Scholar
  15. 15.
    Katirji B, Wilbourn AJ, Scarberry SL, Preston DC. Intrapartum maternal lumbosacral plexopathy. Muscle Nerve. 2002;3:340–7.CrossRefGoogle Scholar
  16. 16.
    Stoehr M. Traumatic and postoperative lesions of the lumbosacral plexus. Arch Neurol. 1978;35:757–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Jang DH, Byun SH, Jeon JY, Lee SJ. The relationship between lumbosacral plexopathy and pelvic fractures. Am J Phys Med Rehabil. 2011;90:707–12.PubMedCrossRefGoogle Scholar
  18. 18.
    Chin CH, Chew KC. Lumbosacral nerve root avulsion. Injury. 1997;28:674–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Crosby ET, Reid DR, DiPrimio G, Grahovac S. Lumbosacral ­plexopathy from iliopsoas haematoma after combined general-­epidural anaesthesia for abdominal aneurysmectomy. Can J Anaesth. 1998;45:46–51.PubMedCrossRefGoogle Scholar
  20. 20.
    Ozcan F, Güray Y, Ozçakar L, Korkmaz S. Inadvertent lumbosacral plexopathy due to temporary pacemaker implantation. J Natl Med Assoc. 2006;98:455–6.PubMedGoogle Scholar
  21. 21.
    Chapman E, Shaw R, Kubik C. Sciatic pain from arteriosclerotic aneurysm of pelvic arteries. N Eng J Med. 1964;271:1410–1.CrossRefGoogle Scholar
  22. 22.
    Gardiner MD, Mangwani J, Williams WW. Aneurysm of the common iliac artery presenting as a lumbosacral plexopathy. J Bone Joint Surg Br. 2006;88:1524–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Fletcher H, Frankel J. Ruptured abdominal aortic aneurysms presenting with unilateral peripheral neuropathy. Surgery. 1976;79:120–1.PubMedGoogle Scholar
  24. 24.
    Larson WL, Wald JJ. Foot drop as a harbinger of aortic occlusion. Muscle Nerve. 1995;18:899–903.PubMedCrossRefGoogle Scholar
  25. 25.
    Chad DA, Bradley WG. Lumbosacral plexopathy. Semin Neurol. 1987;7:97–107.PubMedCrossRefGoogle Scholar
  26. 26.
    Holtzman DM, Davis RE, Greco CM. Lumbosacral plexopathy secondary to perirectal abscess in a patient with HIV infection. Neurology. 1989;39:1400–1.PubMedCrossRefGoogle Scholar
  27. 27.
    Kao CL, Yuan CH, Cheng YY, Chan RC. Lumbosacral plexus injury and brachial plexus injury following prolonged compression. J Chin Med Assoc. 2006;69:543–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Keene R, Froelich JM, Milbrandt JC, Idusuyi OB. Bilateral gluteal compartment syndrome following robotic-assisted prostatectomy. Orthopedics. 2010;33:852.PubMedGoogle Scholar
  29. 29.
    Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment. Muscle Nerve. 2002;4:477–91.CrossRefGoogle Scholar
  30. 30.
    O’Hare J, Abuaisha F, Geoghegan M. Prevalence and forms of neuropathic morbidity in 800 diabetics. Ir J Med Sci. 1994;163:132–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Wilbourn A. Diabetic neuropathies. In: Brown WF, Bolton CF, editors. Clinical electromyography. 2nd ed. Boston: Butterworth-Heinemann; 1993. p. 477–515.Google Scholar
  32. 32.
    Cianfoni A, Luigetti M, Madia F, Conte A, Savino G, Colosimo C, et al. Teaching NeuroImage: MRI of diabetic lumbar plexopathy treated with local steroid injection. Neurology. 2009;72:e32–3.PubMedCrossRefGoogle Scholar
  33. 33.
    Krendel DA, Costigan DA, Hopkins LC. Successful treatment of neuropathies in patients with diabetes mellitus. Arch Neurol. 1995;52:1053–61.PubMedCrossRefGoogle Scholar
  34. 34.
    Said G, Goulon-Goeau C, Lacroix C, Moulonguet A. Nerve biopsy findings in different patterns of proximal diabetic neuropathy. Ann Neurol. 1994;35:559–69.PubMedCrossRefGoogle Scholar
  35. 35.
    Younger D, Rosoklija G, Hays AP, et al. Diabetic peripheral neuropathy: a clinicopathologic and immunohistochemical analysis of sural nerve biopsies. Muscle Nerve. 1996;19:722–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Ogawa T, Taguchi T, Tanaka Y, Ikeguchi K, Nakano I. Intravenous immunoglobulin therapy for diabetic amyotrophy. Intern Med. 2001;40:349–52.PubMedCrossRefGoogle Scholar
  37. 37.
    Kilfoyle D, Kelkar P, Parry GJ. Pulsed methylprednisolone is a safe and effective treatment for diabetic amyotrophy. J Clin Neuromuscul Dis. 2003;4:168–70.PubMedCrossRefGoogle Scholar
  38. 38.
    Donofrio PD, Berger A, Brannagan 3rd TH, Bromberg MB, Howard JF, Latov N, et al. Consensus statement: the use of intravenous immunoglobulin in the treatment of neuromuscular conditions report of the AANEM ad hoc committee. Muscle Nerve. 2009;40:890–900.PubMedCrossRefGoogle Scholar
  39. 39.
    Chan YC, Lo YL, Chan ES. Immunotherapy for diabetic amyotrophy. Cochrane Database Syst Rev. 2009;3:CD006521.PubMedGoogle Scholar
  40. 40.
    Glantz MJ, Burger PC, Friedman AH, Radtke RA, Massey EW, Schold Jr SC. Treatment of radiation-induced nervous system injury with heparin and warfarin. Neurology. 1994;44:2020–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Brunelli G, Brunelli F. Surgical treatment of actinic brachial plexus lesions: free microvascular transfer of the greater omentum. J Reconstr Microsurg. 1985;1:197–200.PubMedCrossRefGoogle Scholar
  42. 42.
    Sander JE, Sharp FR. Lumbosacral plexus neuritis. Neurology. 1981;31:470–3.PubMedGoogle Scholar
  43. 43.
    Evans BA, Stevens JC, Dyck PJ. Lumbosacral plexus neuropathy. Neurology. 1981;31:1327–30.PubMedCrossRefGoogle Scholar
  44. 44.
    Bradley WG, Chad D, Verghese JP, Liu HC, Good P, Gabbai AA, et al. Painful lumbosacral plexopathy with elevated erythrocyte sedimentation rate: a treatable inflammatory syndrome. Ann Neurol. 1984;15:457–64.PubMedCrossRefGoogle Scholar
  45. 45.
    Tarulli A, Rutkove SB. Lumbosacral plexitis. J Clin Neuromuscul Dis. 2005;7:72–8.PubMedCrossRefGoogle Scholar
  46. 46.
    van Alfen N, van Engelen BG. Lumbosacral plexus neuropathy: a case report and review of the literature. Clin Neurol Neurosurg. 1997;99:138–41.PubMedGoogle Scholar
  47. 47.
    Hinchey JA, Preston DC, Logigian EL. Idiopathic lumbosacral neuropathy: a cause of persistent leg pain. Muscle Nerve. 1996;19:1484–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Triggs WJ, Young MS, Eskin T, Valenstein E. Treatment of idiopathic lumbosacral /plexopathy with intravenous immunoglobulin. Muscle Nerve. 1997;20:244–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Kissel J, Slivka A, Warmolts J, Mendell J. The clinical spectrum of necrotizing angiopathy of the peripheral nervous system. Ann Neurol. 1985;18:251–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Sharma KR, Sriram S, Fries T, Bevan HJ, Bradley WG. Lumbosacral radiculoplexopathy as a manifestation of Epstein-Barr virus infection. Neurology. 1993;43:2550–4.PubMedCrossRefGoogle Scholar
  51. 51.
    Garcia-Monco JC, Gomez Beldarrain M, Estrade L. Painful lumbosacral plexitis with increased ESR and Borrelia burgdorferi infection. Neurology. 1993;43:1269.PubMedCrossRefGoogle Scholar
  52. 52.
    Jeevarethinam A, Ihuoma A, Ahmad N. Herpes zoster brachial plexopathy with predominant radial nerve palsy. Clin Med. 2009;9:500–1.PubMedCrossRefGoogle Scholar
  53. 53.
    Almhanna K, Palanichamy N, Sharma M, Hobbs R, Sil A. Unilateral brachial plexopathy associated with West Nile virus meningoencephalitis. Clin Infect Dis. 2003;36:1629–30.PubMedCrossRefGoogle Scholar
  54. 54.
    Stamboulis E, Psimaras A, Malliara-Loulakaki S. Brachial and lumbar plexitis as a reaction to heroin. Drug Alcohol Depend. 1988;22:205–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Challenor YB, Richter RW, Bruun B, Pearson J. Nontraumatic plexitis and heroin addiction. JAMA. 1973;225:958–61.PubMedCrossRefGoogle Scholar
  56. 56.
    Dabby R, Djaldetti R, Gilad R, Herman O, Frand J, Sadeh M, et al. Acute heroin-related neuropathy. J Peripher Nerv Syst. 2006;11:304–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of NeurologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  2. 2.Department of NeurologyPeace Health Southwest Medical CenterVancouverUSA

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