In lumbosacral plexus injuries can we identify indicators that predict spontaneous recovery or the need for surgical treatment? Results from a clinical study on 72 patients

Journal of Brachial Plexus and Peripheral Nerve Injury - Tập 09 Số 01 - Trang e1-e9 - 2014
Debora Garozzo1, Gianluca Zollino1, Stefano Ferraresi1
1Department of Neurosurgery, Ospedale S. Maria della Misericordia, Viale Tre Martiri 140, 45100 Rovigo, Italy

Tóm tắt

Background Post-traumatic lumbosacral plexus injuries seem to be rare events, spontaneously recovering in high percentage: as surgery is often challenging and results in poor outcome, many Authors have advocated conservative treatment only. Nevertheless surgery should not be ruled out: in invalidating injuries, it can restore basic function in the lower extremities.Therefore, it might be necessary to establish guidelines for the management and the indication to surgery in such cases.This study aims to identify indicators predicting spontaneous recovery or the need for surgery. Method The clinical and radiological data of 72 patients with a post-traumatic lumbosacral plexus injury were reviewed. A follow up equal or superior to 3 years is available in 42 cases. Results Lumbosacral plexus injuries mostly occurred during road accidents. The incidence of associated lesions was relevant: bone injuries were found in 85% of patients, internal lesions in 30% and vascular injuries in 8%.Lumbosacral trunk and sacral plexus palsies were the most frequent injury patterns.Root avulsions were revealed in 23% of cases and only in sacral plexus and complete lumbosacral plexus injuries: L5 and S1 were the roots more prone to avulsions.About 70% of cases recovered spontaneously, mostly in 18 months. Spontaneous recovery was the rule in lumbar plexus and lumbosacral trunk injuries (where root avulsions never occurred) or in sacral and complete lumbosacral plexus palsies due to compression injuries.The causative mechanism correlated with the injury pattern, the associated bone injury being often predictive of the severity of the nerve injury.Lumbosacral plexus injuries occurred in car crashes were generally associated with fractures causing compression on the nerves, thus resulting in injuries often amenable of spontaneous recovery.Motorcycle accidents implied high kinetic energy traumas where traction played an important role, as the high percentage of sacroiliac joint separations demonstrated (found in more than 50% of cases and always associated to root avulsions).Loss of sphincteral control and excruciating leg pain were also invariably associated with avulsions. Conclusions Clinical and radiological data can help to predict the occurrence of spontaneous recovery or the need for surgery in post-traumatic lumbosacral plexus injuries.

Từ khóa


Tài liệu tham khảo

G Casserio, 1632, Tabulalae Anatomicae

LA Finney, 1960, Traumatic intradural lumbar nerve root avulsion with associated traction injury to the common peroneal nerve, AM J Roentgenol Radium Ther Nucl Med, 84, 952

VM Huittinen, 1972, Nerve injury in double vertical pelvic fractures, Acta Chir Scand, 138, 571

JE McLennan, 1973, Traumatic lumbar nerve root meningocele. Case report, J Neurosurg, 39, 528, 10.3171/jns.1973.39.4.0528

M Stoehr, 1978, Traumatic and postoperative lesions of the lumbosacral plexus, Arch Neurol, 35, 757, 10.1001/archneur.1978.00500350061013

J Tonetti, 2004, Neurological damage in pelvic injuries: a continuous prospective series of 50 pelvic injuries treated with an iliosacral lag screw, Rev Chir Orthop Reparatrice Appar Mot, 90, 122

E Lang, 2004, Surgical treatment of lumbosacral plexus injuries, J Neurosurg, 64

Medical Research Council Scale, 1976, Aids to the examination of the peripehral nervous system. Memorandum n°45

J Lindahl, 2005, Outcome of operatively treated type-C injuries of the pelvic ring, Acta Orthop, 76, 667, 10.1080/17453670510041754

O Hersche, 1993, Follow up and prognosis of neurological sequelae of pelvic ring fractures with involment of the sacrum and /or the iliosacral joint, Unfallchirug, 96, 311

EB Weis jr, 1984, Subtle neurological injuries in pelvic fractures, J Trauma, 24, 983, 10.1097/00005373-198411000-00010

HJ Barnett, 1975, Lumbosacral nerve root avulsion: report of a case and review of the literature, J Trauma, 15, 532, 10.1097/00005373-197506000-00015

SK Rai, 1990, Neurological deficits associated with sacral wing fractures, Orthopedics, 13, 1363, 10.3928/0147-7447-19901201-07

F Denis, 1988, Sacral fractures: an important problem. Retrospective analysis of 236 cases, Clin Orthop, 227, 67, 10.1097/00003086-198802000-00010

SA Majeed, 1992, Neurologic deficits in major pelvic injuries, Clin Orthop, 282, 22, 10.1097/00003086-199209000-00029

CP Sabiston, 1986, Sacral fractures: classification and neurologic implications, J Trauma, 6, 197

JG Bonin, 1945, Sacral fractures and injuries of the cauda equina, J Bone Join Surg (Br), 27, 113

C Froman, 1967, Complicated crushing injuries of the pelvis, J Bone Join Surg (Br), 49, 24, 10.1302/0301-620X.49B1.24

K Ikeda, 1991, Traction injury of the lumbosacral spinal nerve roots, Spine, 16, 368, 10.1097/00007632-199103000-00021

C Chotigavanich, 1992, Anomalies of the lumbosacral nerve roots. An anatomic investigation, Clin Orthop Res, 278, 46, 10.1097/00003086-199205000-00007

G Stevanato, 2007, Lumbosacral plexus lesions, Acta Neurochir Suppl, 100, 15, 10.1007/978-3-211-72958-8_3

Thông tin
Thông tin xuất bản

Journal of Brachial Plexus and Peripheral Nerve Injury

Tập 09 Số 01

e1-e9

Thông tin tác giả