304 - Early Recovery from Bilateral Traumatic Lumbosacral Plexopathy: A Case Report

Case Diagnosis: Bilateral Lumbosacral Plexopathy Secondary to Polytrauma

Case Description: 33-year-old male presented to clinic for evaluation of lower extremity dysfunction secondary to polytrauma 6-weeks earlier. Injuries included obturator ring and sacral fractures, with resultant numbness and paresthesia in bilateral lower extremities. He also had dysesthesias and weakness in the left. Notable physical exam findings included left gastrocnemius atrophy, 3/5 strength with left foot plantarflexion, positive Tinel sign and compression test along sciatic nerve in posterior left knee, altered sensation in posterior left leg, and altered sensation in bilateral feet. EMG/NCS revealed bilateral traumatic lumbosacral plexopathy affecting the lumbosacral trunk/sacral plexus, which was worse in the left, with evidence of early regeneration/recovery. After management with physical therapy and gabapentin for 7-months, he had complete resolution of right lower extremity symptoms. His left lower extremity symptoms had also improved significantly, with at least 4+/5 strength in all myotomes and altered sensation only on the dorsum of the last two toes.

Discussions: Lumbosacral plexopathy is a rare clinical entity that can be caused by trauma, with the resultant sensory and motor dysfunction often leading to severe neurologic deficits. Although less frequent than brachial plexopathies due to anatomic locations of the different plexuses, studies have shown between 0.7% - 2.03% incidence of lumbosacral plexopathy secondary to trauma. This diagnosis has a very poor prognosis, often requiring about 18-months to notice a marked improvement in the small population of individuals that make significant recovery.

Conclusions: This case highlights an atypical course of recovery after bilateral traumatic lumbosacral plexopathy that can be attributed to early diagnosis and management. Given the poor prognosis associated with this diagnosis, early recognition with electrodiagnostic studies is key to initiating proper treatment with neuropathic medications and timely physical therapy after weight-bearing clearance.