Diagnosis and Treatment of Lumbosacral Plexopathies in Patients With Cancer

Pettigrew, L. C.; Glass, J. P.; Maor, M.H.; Zornoza, J

doi:10.1001/archneur.1984.04050230068022

Cited by 61 publications

(17 citation statements)

References 13 publications

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“…Lumbosacral plexopathy can be caused by damage to the lumbosacral plexus from direct tumor infiltration from adjacent soft tissue or lymph nodes, or by compression from metastases in the adjacent bony pelvis [2,3,4,5]. Most lumbosacral plexopathy reflects local extension or nodal metastases from colorectal and other pelvic tumors (cervix, uterus, bladder or prostate), sarcoma and lymphomas, but it also occurs with metastases from breast or lung cancer or melanoma [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, involvement of the lumbosacral plexus is almost always unilateral, and the life expectancy of patients is mostly up to 6 months [2,3,4,5]. Considering these clinical characteristics, it seems that medically refractory, well-localized neuropathic pain from carcinomatous lumbosacral plexopathies would be an ideal candidate for neuroablative treatment aiming to interrupt pain-transmitting pathways.…”

Section: Discussionmentioning

confidence: 99%

“…The lumbosacral plexus is generally invaded by primary pelvic neoplasms, but occasionally is affected by growth from metastases to regional lymph nodes or bony structures. Regardless of the location, neoplastic plexopathy is often characterized by severe and unremitting pain [2,3]. Treatment of metastatic plexopathy is usually palliative and the response to therapy is modest and generally short-lived.…”

Section: Introductionmentioning

confidence: 99%

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Dorsal Rhizotomy for Pain from Neoplastic Lumbosacral Plexopathy in Advanced Pelvic Cancer

Son

Yoon²,

Kim

et al. 2014

Stereotact Funct Neurosurg

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Background: Pain from neoplastic lumbosacral plexopathy is resistant to conventional pain treatment. According to a recent review of destructive procedures for cancer pain, only cordotomy has been reported to play an important role in the treatment of cancer pain. To date, the effectiveness of dorsal rhizotomy, which selectively interrupts pain transmission, has not been shown in neoplastic lumbosacral plexopathy. Objectives: The present study seeks to find out the effectiveness of selective dorsal rhizotomies for intractable pain from neoplastic lumbosacral plexopathy in terminal pelvic cancer patients. Methods: Dorsal rhizotomies of the involved segments were performed on 6 cancer patients in whom neuropathic pain from lumbosacral plexus involvement in terminal pelvic cancer had been refractory to other therapies. Clinical efficacy of the procedure was assessed by comparing patient pain ratings and narcotic usage before and after dorsal rhizotomy. Results: Examination of the results indicated a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed and no recurrence of pain from neoplastic lumbosacral plexopathy was noted. Conclusions: These findings provide corroborating clinical evidence for the effectiveness of selective dorsal root rhizotomy for the intractable pain from lumbosacral plexopathy in terminal pelvic cancer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dorsal Rhizotomy for Pain from Neoplastic Lumbosacral Plexopathy in Advanced Pelvic Cancer

Son

Yoon²,

Kim

et al. 2014

Stereotact Funct Neurosurg

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“…Ces lésions, parfois tardives, peuvent altérer les différentes voies du contrôle vésicosphinctérien en cas de radiothérapie pelvienne [1][2][3][4][5][6][7]. Toutes les structures nerveuses peuvent être touchées, qu'il s'agisse de lésion des centres réflexes médullaires, des voies de conduction périphériques ou encore des plexus [8][9][10][11].…”

Section: Introductionunclassified

Les complications neuropérinéales de la radiothérapie pelvienne

et al. 2010

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La radiothérapie pelvienne peut déterminer diverses complications neurologiques. La myélite radiothérapique est la plus fréquente, mais des plexopathies sacrées postradiques peuvent aussi survenir. Les troubles mictionnels sont caractérisés par un syndrome clinique d'hyperactivité vésicale avec pollakiurie, incontinence sur urgence et impé-riosité, secondaire à une hyperactivité du détrusor ou à un défaut de compliance. En cas d'atteinte neurogène purement périphérique, rétention urinaire et fuite sur défaillance sphinctérienne peuvent s'observer. Mots clés Radiothérapie · Myélopathie radique · Plexite sacrée · IncontinenceAbstract Pelvic irradiation can lead to various neurologic syndromes. Radiation myelopathy is the most common lesion, but acute and chronic lumbosacral plexopathy can occur several months or years after pelvic irradiation. Micturitional disturbances are characterized by overactive bladder syndrome with frequency, urgency, and urge incontinence. These symptoms are secondary to detrusor overactivity or compliance alteration during the filling phase. In case of neurogenic peripheral lesions, urinary retention and stress incontinence following lack of urethral sphincter pressures are observed.

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“…The pathogenesis is still unknown and no treatment for these diseases is currently available [8,Table]. Some improvement after treatment with steroids [5,6] and high dose intravenous immunoglobulin (IVIg [7]) has been occasionally reported suggesting a possible immunological involvement.…”

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confidence: 99%