Lumbar / Pelvis

Lumbar Plexus Neuralgia

Definition

Traumatic lumbar plexus lesions are caused by damage due to overstretching this plexus, together with possible avulsion of the nerve roots. As a consequence, patients experience neurological deficit and/or pain in the area of the peripheral nerve of the plexus.

Aetiology

The most frequent causes are high-energy trauma, sports injuries, penetrating trauma, and surgery that results in damage to the plexus. In particular, injuries that cause damage between the spinal cord and spinal ganglion (proximal) lead to severe pain.

Signs and symptoms

Apart from severe neurological deficit, neuropathic pain of the leg (deafferentiation pain) is the main symptom in 30-90% of patients with a plexus lesion.

In the case of preganglion lesions (avulsion of the nerve root near the spinal cord), the chance of severe neuropathic pain rises to 90%. In these patients, pain occurs after a pain-free interval.

The initially continuous 'background pain' with its burning or stabbing character, is later reinforced by the occurrence of additional spontaneous attacks of pain.

These attacks of pain are predominantly located in the distal part of the leg, foot and toes. A clear radicular pain pattern is not usually recognisable.

When there is combined damage of the spinal cord and plexus, it is very difficult to come to a diagnosis of a plexus lesion, and this is frequently delayed.

Diagnostics

Physical Examination

The neurological examination focuses on sensory and motor deficits. If no history of trauma is present, differential diagnostically intra-abdominal pathology must be considered.

Additional Somatic Diagnostics

  • Additional examinations when serious trauma is seen on standard X-rays, and CT and MRI scans.
  • CT myelography for nerve root avulsion.
  • Neurophysiological evaluation (EMG and SSEP) to localise the course of the disease, and neurosurgical intervention.
  • RAND-36 (quality of life)
  • VAS Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment consisting of various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Tricyclic antidepressants
  • Anticonvulsives: carbamazepine, oxcarbazepine, gabapentine en pregabaline.

Other Treatments

Interventional Pain Treatment

Invasive Treatment

  • Neurosurgical plexus reconstruction