Abstract Details

Title Lumbosacral Plexopathy: A Comprehensive Analysis of Etiology, Clinical Presentation, Electrodiagnostic Findings, and Long-term Outcomes

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 9-019

Objective To evaluate the prevalence of various LSP etiologies, analyze clinical/electrodiagnostic(EDx) features, and describe patient outcomes.

Background Lumbosacral plexopathy (LSP) results from a spectrum of etiologies, causing significant functional impairment. Limited data exist on the prevalence, diagnostic features, and long-term outcomes. This study aimed to elucidate etiologies, clinical findings, EDx characteristics, and outcomes of LSP.

Design/Methods We retrospectively reviewed records of patients diagnosed with LSP at our center from January 2000 to September 2024. Definite LSP was defined by weakness in muscles innervated by at least two lumbosacral nerves, with EDx evidence of multi-nerve involvement with asymmetric sensory involvement or corresponding imaging abnormalities. Probable LSP met similar clinical criteria but lacked definitive EDx or imaging confirmation and was not attributable to radiculopathy or other mimics.

Results Of 1,139 screened records, 124 patients met criteria for LSP (38 definite[30.6%], 86 probable[69.4%]). Median age was 61.8 years(mean±SD: 61.8±15.0), and 59(47.6%) were female. Symptom onset was acute in 47(37.9%), subacute in 9(7.3%), and chronic in 68(54.8%). Sensorimotor symptoms predominated(71.0%) in our cohort. Leading etiologies included diabetes(34.7%), post-operative injury(25.8%), and idiopathic case(14.5%). EDx was performed a median of 4.0 months after symptom onset. Sural sensory nerve action potentials were often absent(median 0 µV), and abnormal spontaneous activity on needle EMG was observed in 89 of 94 cases(94.7%). Recruitment abnormalities were moderate in 68(72.3%), severe in 12(12.8%), mild in 8(8.5%); in (3.2%), motor units were absent. Management included neuropathic pain therapie (51.6%), physical therapy(62.1%), corticosteroids (3.2%), and immunotherapies(4.0%). Among 85 patients with follow-up, 35(41.2%) achieved full or near-complete recovery.

Conclusions Diabetes was the most common etiology of LSP, followed by post-operative and idiopathic causes. While partial sensorimotor improvement was frequent, full recovery was uncommon and often delayed. These findings underscore the importance of early recognition and comprehensive evaluation to guide tailored therapeutic strategies for optimizing outcomes in LSP.

Authors/Disclosures
Jad El Ahdab, MD PRESENTER	Dr. El Ahdab has nothing to disclose.
Bradley G. Ong, MD (Cleveland Clinic Main Campus - Neurological Institute)	The institution of Dr. Ong has received research support from American Academy of Neurology. The institution of Dr. Ong has received research support from American Headache Society. Dr. Ong has received personal compensation in the range of $0-$499 for serving as a Expert Witness with Chandler Advocacy. Dr. Ong has a non-compensated relationship as a Editorial Board Member with Neurology Resident & Fellow Section that is relevant to AAN interests or activities. Dr. Ong has a non-compensated relationship as a Contributor with Neurology Minute that is relevant to AAN interests or activities.
Nicholas Thompson	The institution of Nicholas Thompson has received research support from EMD Serono.
hong li, PhD	Dr. li has nothing to disclose.
Nirmal Andrapalliyal, MD (Cleveland Clinic)	Dr. Andrapalliyal has nothing to disclose.