Traumatic Lesions of the Lumbosacral Plexus: Microsurgical Treatment

In severely injured patients there is sometimes complete palsy of an inferior limb. This may be the expression of a lesion of the innervation of the limb at various anatomical levels; the cauda, nerve roots inside the foramina, different elements of the lumbosacral plexus, or the terminal branches may be involved. Traumatic lesions of the lumbosacral plexus are rarely reported in the literature. This is because (a) these are rare lesions, intraspinal aside from lesions of the cauda and of nerve roots and lesions of terminal branches, (b) the correct diagnosis is difficult since these anatomical structures are deep seated and not easily studied, even by modem diagnostic tools, and (c) the surgical approach is difficult since the microsurgical field is very deep, and the nerves are covered by large vessels and muscles very adherent to the spine. Diagnosis is difficult because the lesions are often multiple and are located in different anatomical sites: intra or extraspinal, pre-, intra-, or postplexal. The problem is complicated by the frequent association with severe bony lesions in the spine, lumbosacral junction, or coxofemoral articulation. The entailed problems of stability and their treatment may delay diagnosis and treatment of neural damage.