Radiation-induced lumbosacral plexopathy and pelvic insufficiency fracture: A case report of unique coexistence of complications after radiotherapy for prostate cancer

• Published in: Joint diseases and related surgery 2024-03, Vol.35 (2), p.455-461
• Main Authors: Güler, Tuba, Yurdakul, Fatma Gül, Karasimav, Özlem, Kılıç, Zeynep, Yaşar, Evren, Bodur, Hatice
• Format: Article
• Language: English
• Subjects: Aged; Case Report; Fractures, Stress - diagnostic imaging; Fractures, Stress - etiology; Humans; Lumbosacral Plexus - injuries; Lumbosacral Plexus - pathology; Lumbosacral Plexus - radiation effects; Magnetic Resonance Imaging; Male; Pelvic Bones - diagnostic imaging; Pelvic Bones - injuries; Pelvic Bones - pathology; Pelvic Bones - radiation effects; Peripheral Nervous System Diseases - etiology; Prostatic Neoplasms - radiotherapy; Radiation Injuries - diagnostic imaging; Radiation Injuries - etiology; Radiotherapy - adverse effects
• ISSN: 2687-4784; 2687-4792; 2687-4792
• DOI: 10.52312/jdrs.2024.1551

Case reports of plexopathy after prostate cancer are usually neoplastic. Radiation-induced lumbosacral plexopathy and insufficiency fractures have clinical significance due to the need to differentiate them from tumoral invasions, metastases, and spinal pathologies. Certain nuances, including clinical presentation and screening methods, help distinguish radiation-induced plexopathy from tumoral plexopathy. This case report highlights the coexistence of these two rare clinical conditions. Herein, we present a 78-year-old male with a history of radiotherapy for prostate cancer who developed right foot drop, severe lower back and right groin pain, difficulty in standing up and walking, and tingling in both legs over the past month during remission. The diagnosis of lumbosacral plexopathy and pelvic insufficiency fracture was made based on magnetic resonance imaging, positron emission tomography, and electroneuromyography. The patient received conservative symptomatic treatment and was discharged with the use of a cane for mobility. Radiation-induced lumbosacral plexopathy following prostate cancer should be kept in mind in patients with neurological disorders of the lower limbs. Pelvic insufficiency fracture should also be considered if the pain does not correspond to the clinical findings of plexopathy. These two pathologies, which can be challenging to diagnose, may require surgical or complex management approaches. However, in this patient, conservative therapies led to an improvement in quality of life and a reduction in the burden of illness.