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Radiation-induced lumbar plexopathy (RILP) or radiation-induced lumbosacral plexopathy (RILSP) is nerve damage in the pelvis and lower spine area caused by therapeutic radiation treatments. RILP is a rare side effect of external beam radiation therapy [ 1 ] [ 2 ] [ 3 ] and both interstitial and intracavity brachytherapy radiation implants.
Management of brachial or lumbosacral plexopathy depends on the underlying cause. No matter the cause of plexopathy, physical therapy and/or occupational therapy may promote recovery of strength and improve limb function. In the case of a mass lesion causing compression of the brachial or lumbosacral plexus, surgical decompression may be warranted.
However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot.
Bertolotti's syndrome is characterized by sacralization of the lowest lumbar vertebral body and lumbarization of the uppermost sacral segment. It involves a total or partial unilateral or bilateral fusion of the transverse process of the lowest lumbar vertebra to the sacrum, leading to the formation of a transitional 5th lumbar vertebra.
Neurogenic claudication must be differentiated from other causes of leg pain, which may be present in a number of conditions involving the spine and musculoskeletal system. The differential diagnosis for NC includes: [9] Vascular claudication; Lumbosacral radicular pain secondary to lumbar disc herniation
Despite this, the use of imaging in low back pain has increased. [10] Some low back pain is caused by damaged intervertebral discs, and the straight leg raise test is useful to identify this cause. [5] In those with chronic pain, the pain processing system may malfunction, causing large amounts of pain in response to non-serious events. [11]
Dural ectasia is defined as a ballooning or outpouching of the dura with a dural volume greater than two standard deviations above the mean value in controls. [9] It is usually identified by MRI or CT Scan, [7] which can be used to distinguish it from tumors. [16]
The cysts may be found anterior to the sacral area and have been known to extend into the abdominal cavity. These cysts, though rare, can be found to grow large - over 3–4 centimetres (1.2–1.6 in) in size, often causing severe abdominal pain from compression on the cyst itself as well as adjoining nerves. [citation needed]