Abstract
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.
Keywords Lumbosacral plexus - Nerve injury - Root avulsions - Pelvic trauma - Sacroiliac joint
separation - Sacral fracture
