Bilateral postoperative lumbosacral plexopathy: A case report

Abstract

Introduction: Lumbosacral plexopathy is a rare diagnosis that can be challenging to confirm, particularly because it often lacks clear structural or laboratory abnormalities. Diagnosis is primarily based on imaging and neurophysiological studies. However, some cases are idiopathic and are believed to have an autoimmune background.

Case presentation: We report a case of a male patient with a history of two spinal surgeries performed for persistent back pain. He later presented to the neurology clinic with a triad of lower limb muscle weakness, sensory loss, and pain. After comprehensive evaluation, a diagnosis of bilateral idiopathic lumbosacral plexopathy was reached by exclusion. The patient was started on a rehabilitation program and symptomatic therapy for pain control, showing significant improvement. Early diagnosis and timely intervention played a key role in the favorable outcome.

Discussion: The triad of muscle weakness, sensory loss, and pain is commonly associated with plexopathies. However, lumbosacral plexopathy is rare, typically unilateral, and often related to poorly controlled diabetes, making the diagnosis of bilateral idiopathic lumbosacral plexopathy especially challenging. Early diagnosis via imaging and neurophysiological studies facilitated an improved outcome.

Conclusion: Although rare, lumbosacral plexopathy can significantly impair quality of life. Clinicians should consider this diagnosis to prevent delayed treatment and prolonged suffering.

Keywords: Idiopathic; Lumbosacral; Plexopathy; Postoperative.

Fig. 1

Needle EMG showing denervation changes in the tibialis anterior and vastus medialis muscles bilaterally, with no abnormal activity in paraspinal muscles—supportive of lumbosacral plexopathy.

Fig. 2

MRI of the lumbar spine demonstrating no evidence of compressive lesions or hematoma; incidental findings include mild degenerative disc changes without clinical correlation.