Radiation-Induced Lumbosacral Plexopathy Workup

  • Author: Rajesh R Yadav, MD; Chief Editor: Robert H Meier III, MD   more...
 
Updated: Dec 6, 2011
 

Imaging Studies

  • Routine spine and pelvis radiographs and myelograms are unremarkable in lumbosacral plexopathy.
  • The diagnosis of radiation plexopathy can be supported by diagnostic studies, such as computed tomography (CT) scanning and magnetic resonance imaging (MRI) of the pelvis. MRI is more sensitive than is CT scanning in detecting tumor recurrence.[10, 11] Enhancement of nerve roots and T2-weighted hyperintensity usually suggests tumor. Unfortunately, differentiation from tumor recurrence remains difficult. Generally, radiation plexopathy does not produce nerve enhancement. Positron emission tomography (PET) scanning with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) may be helpful in diagnosing recurrent tumor.
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Other Tests

  • Electromyography (EMG) reveals myokymic discharges in most patients (57%) with radiation-induced lumbosacral plexopathy. Such changes occur over years; however, the absence of myokymia does not exclude radiation injury. EMG in clinically weak muscles also may reveal fibrillation potentials (ie, chronic, neurogenic motor unit changes with decreased recruitment). Paraspinal involvement occurs in 50% of cases. Compound muscle action potential (CMAP) of motor nerves may be low.[12, 13]
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Contributor Information and Disclosures
Author

Rajesh R Yadav, MD  Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas Medical School at Houston

Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert J Kaplan, MD  James E Van Zandt VA Medical Center, Staff Physician, Department of Rehabilitation Medicine

Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier III, MD  Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke's Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

References

  1. Pettigrew LC, Glass JP, Maor M, et al. Diagnosis and treatment of lumbosacral plexopathies in patients with cancer. Arch Neurol. Dec 1984;41(12):1282-5. [Medline].

  2. Ashenhurst EM, Quartey GR, Starreveld A. Lumbo-sacral radiculopathy induced by radiation. Can J Neurol Sci. Nov 1977;4(4):259-63. [Medline].

  3. Jaeckle KA, Young DF, Foley KM. The natural history of lumbosacral plexopathy in cancer. Neurology. Jan 1985;35(1):8-15. [Medline].

  4. Abu-Rustum NR, Rajbhandari D, Glusman S, et al. Acute lower extremity paralysis following radiation therapy for cervical cancer. Gynecol Oncol. Oct 1999;75(1):152-4. [Medline].

  5. Iglicki F, Coffin B, Ille O, et al. Fecal incontinence after pelvic radiotherapy: evidences for a lumbosacral plexopathy. Report of a case. Dis Colon Rectum. Apr 1996;39(4):465-7. [Medline].

  6. Jaeckle KA. Neurological manifestations of neoplastic and radiation-induced plexopathies. Semin Neurol. Dec 2004;24(4):385-93. [Medline].

  7. Jaeckle KA. Neurologic manifestations of neoplastic and radiation-induced plexopathies. Semin Neurol. Jul 2010;30(3):254-62. [Medline].

  8. Ozkavukcu E, Cayli E, Yagci C, et al. Ruptured iliac aneurysm presenting as lumbosacral plexopathy. Diagn Interv Radiol. Mar 2008;14(1):26-8. [Medline]. [Full Text].

  9. Abdellaoui A, West NJ, Tomlinson MA, et al. Lower limb paralysis from ischaemic neuropathy of the lumbosacral plexus following aorto-iliac procedures. Interact Cardiovasc Thorac Surg. Aug 2007;6(4):501-2. [Medline]. [Full Text].

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  12. Wilbourn AJ. Electrodiagnosis of plexopathies. Neurol Clin. Aug 1985;3(3):511-29. [Medline].

  13. Masakado Y, Kawakami M, Suzuki K, et al. Clinical neurophysiology in the diagnosis of peroneal nerve palsy. Keio J Med. Jun 2008;57(2):84-9. [Medline].

  14. Pritchard J, Anand P, Broome J, et al. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiother Oncol. Mar 2001;58(3):279-86. [Medline].

  15. Enevoldson TP, Scadding JW, Rustin GJ, et al. Spontaneous resolution of a postirradiation lumbosacral plexopathy. Neurology. Nov 1992;42(11):2224-5. [Medline].

  16. Bradley WG, Fewings JD, Cumming WJ, et al. Delayed myeloradiculopathy produced by spinal X-irradiation in the rat. J Neurol Sci. Jan-Feb 1977;31(1):63-82. [Medline].

  17. Cavanagh JB. Prior x-irradiation and the cellular response to nerve crush: duration of effect. Exp Neurol. Oct 1968;22(2):253-8. [Medline].

  18. Dahele M, Davey P, Reingold S, et al. Radiation-induced lumbo-sacral plexopathy (RILSP): an important enigma. Clin Oncol (R Coll Radiol). Jun 2006;18(5):427-8. [Medline].

  19. Glantz MJ, Burger PC, Friedman AH. Treatment of radiation-induced nervous system injury with heparin and warfarin. Neurology. Nov 1994;44(11):2020-7. [Medline].

  20. Stryker JA, Sommerville K, Perez R, et al. Sacral plexus injury after radiotherapy for carcinoma of cervix. Cancer. Oct 1 1990;66(7):1488-92. [Medline].

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  22. Thomas JE, Cascino TL, Earle JD. Differential diagnosis between radiation and tumor plexopathy of the pelvis. Neurology. Jan 1985;35(1):1-7. [Medline].

 
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