Intravenous immunoglobulin therapy for idiopathic postoperative lumbosacral plexopathy.
We report a patient who developed an acute lumbosacral plexopathy (LSP) following spinal surgery on lumbos segments. He recovered dramatically following treatment with high-dose intravenous immunoglobulin (IVIg). A 66-year-old man who underwent an L4 to S1 decompressive laminectomy required re-admission after developing contralateral leg pain. Follow-up lumbosacral magnetic resonance imaging showed only mild postoperative changes. Ten days after re-admission, he developed relatively rapid onset ipsilateral inguinal pain and weakness of all his leg muscles with diminished sensation in a lumbosacral plexus distribution. Re-exploration revealed no specific lesion except for adhesions and resulted in no improvement. Following treatment with IVIg (0.4 g/kg daily) for five days, he showed dramatic resolution of motor weakness and pain. There has been no relapse following six months follow-up. Although IVIg treatment does not guarantee a positive response in all types of LSP, it should be considered for severe, rapidly progressive and even for postoperative cases.
Park
Dong-Hyuk
DH
Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea.
Park
Youn-Kwan
YK
Kim
Joo-Han
JH
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D020516:Brachial Plexus Neuropathies / Q000628:therapy*; D019299:Decompression, Surgical; D006801:Humans; D007116:Immunization, Passive; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000628:therapy*; D013116:Spinal Cord / Q000601:surgery
D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D008775:Methylprednisolone