Disclosures: Vincent Thieu, BSE: No financial relationships or conflicts of interest

Case Diagnosis: A patient developed a right sacral fracture, left lumbosacral plexopathy (LSP), and complex regional pain syndrome type 2 (CRPS) of left lower extremity after undergoing forceps delivery.

Case Description or Program Description: A 33-year-old female was referred to the clinic for 2 months of left leg numbness and weakness. Initial symptoms of foot drop and left lower extremity numbness began immediately after undergoing forceps delivery secondary to maternal exhaustion and fetal tachycardia. Physical exam showed normal right leg strength and normal left hip flexion with weakness of left knee extension, ankle dorsiflexion, and ankle plantarflexion. Sensation was diminished to light touch from left knee to ankle.

Setting: Outpatient spine center at a freestanding rehabilitation hospital

Assessment/Results: Initial electrodiagnostic (EDX) testing 1 month post-delivery showed LSP affecting the left lumbosacral trunk with the peroneal distribution most affected. Pelvic MRI revealed right superior sacral ala fracture. Repeat EDX studies 4 months post-delivery demonstrated improved motor and sensory amplitude consistent with continued axonal recovery. The case was complicated by CRPS in the left leg and foot, which contributed significantly to functional deficits. Subsequent treatment of gabapentin was started in addition to a comprehensive pain program for management of CRPS that included physical, occupational, and psychological therapy. Currently, the patient continues to make progress with improved strength and pain management.

Discussion (relevance): While LSP is a rare but known complication of vaginal deliveries, the causes of intrapartum LSP remain a complex topic. Here, we present a unique case in which the patient suffers both right sacral fracture and left LSP following forceps delivery. This is the first reported case, to our knowledge, of LSP with contralateral sacral stress fracture after a vaginal delivery with forceps.

Conclusions: For postpartum patients diagnosed with lumbosacral plexopathy, practitioners should consider additional complications associated with delivery including sacral stress fractures, especially if forceps were used.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/lumbosacral-plexopathy-and-sacral-fracture-after-forceps-delivery-a-case-report/