| 제목 |
The clinical outcome of lumbosacral plexopathy according to the extent and etiology of the injury. |
| 소속 |
St. Vincent’s Hospital, Korea., Department of Rehabilitation Medicine1 |
| 저자 |
Won Jin Sung1*, Seong Hoon Lim1†, Joon Sung Kim1, Bo Young Hong1, Bo Mi Sul1, Jung Jae Lee1 |
Introduction & Background
The lumbosacral plexopathy is defined as a neurological disorder derived from lumbosacral plexus(composed of both the upper lumbar and lower lumbosacral plexuses). The causes of lumbosacral plexopathy vary widely, ranging from pelvic trauma or compressive causes(i.e.; hematoma) to neoplastic or vascular diseases. Although a Few studies have investigated the clinical outcome of lumbosacral plexopathy, the clinical findings and outcomes of lumbosacral plexopathy are not yet clear. This study investigated the clinical outcome of lumbosacral plexopathy in terms of the extent and etiology of the injury.
Methods
We designed a retrospective study. We reviewed the medical records of 23 lumbosacral plexopathy patients who presented between January 2011 and December 2017 to the Department of Rehabilitation Medicine of one university hospital in Korea. All of the patients were diagnosed with lumbosacral plexopathy after careful clinical and electrophysiologic evaluation. They were divided into different groups according to the etiology and extent of their injuries and the clinical outcomes of each group at one year after onset were investigated. Clinical outcomes were classified into the following four categories. “Full recovery” includes patients with complete recovery of their neurologic symptoms. “Able to walk” and “unable to walk” depend on the availability of independent walking, and finally “loss to follow-up” for those patients who we lost track of. The anatomic extent of the nerve injury of each patient was confirmed by thorough nerve conduction study and needle electromyography.
Results
We reviewed the histories and the results of electrodiagnostic studies of 23 patients (mean age 43.3±16.1; 13 males, 10 females)[Fig 1]. Right lumbosacral plexus was involved in 11 patients, left lumbosacral plexus in 8, and bilateral plexuses in 4. Among the 27 lumbosacral plexuses(due to 4 patients with bilateral lesions), upper lumbar plexus was involved in 6 cases, lower lumbosacral plexus in 12, and the whole lumbosacral plexus in 9. There were 13 cases which arose from traumatic event, and the rest were non-traumatic. When the clinical outcomes between the groups were compared, Non-traumatic cases showed higher rates of “full recovery” than traumatic cases[Fig 2-a]. Those with lesions in the upper lumbar plexus had a higher chances of “full recovery” than the others[Fig 2-b].
Conclusion
Patients with non-traumatic lumbosacral plexopathy showed better outcomes than those with traumatic plexopathy. Furthermore, those with injuries limited to upper lumbar plexus showed better outcomes than those with injuries involving lower lumbosacral plexus or whole lumbosacral plexus. There results will be useful when planning treatment strategies and will deepen our understanding of prognosis of lumbosacral plexopathy.
|
|
Fig 1. Clinical characteristics of patients.
Fig 2-a Clinical outcome of lumbosacral plexopathy according to etiology(trauma vs non-trauma)
Fig 2-b Clinical outcome of lumbosacral plexopathy according to the injury extent.
|
