Unilateral to Bilateral Progressive Sciatic Neuropathy After Radiotherapy: A Case Report

Background:

Radiation therapy is often an adjunct treatment for prostate cancer. However, this procedure is not without risks; as the lumbosacral plexus is not routinely contoured during radiotherapy treatment plans, this raises potential for unintended consequences. As this case, especially this particular presentation, is an extremely rare occurrence, we will examine relevant literature and discuss the challenging diagnosis.

Case Presentation:

In this report, we detail the case of a 66-year-old male patient who suffered from unilateral sciatic neuropathy. Unfortunately, this unilateral neuropathy became bilateral, and was deemed idiopathic at the time, causing the patient severe distress. However, further workup which consisted of examination of patient history, scrutinizing imaging, and electromyography (EMG), painted a different picture. The onset of the patient’s complaints appeared to be initiated by adaptive radiotherapy, which the patient underwent during his treatment regimen for prostate cancer.

Conclusions:

As radiation-induced lumbosacral plexopathy (RILSP) may present in a delayed fashion after treatment, diagnosis could become difficult. While radiculopathy was the differential diagnosis which initially led to neurosurgical consultation, the patient’s presentation did not align with this diagnosis. Further workup, especially strategic usage of EMG, allowed for discernment of a neuropathic condition, versus a mechanically induced radiculopathy. While RILSP appears to be an underreported phenomenon subsequent to pelvic radiation, there exists only one other case of such neuropathy after prostate radiotherapy. Knowledge of this case will enable clinicians to modify their workup and avoid spine surgery in cases where it may cause harm.