LUMBAR PLEXUS LESION ASSOCIATED WITH SPINAL MANIPULATION: A CASE REPORT

Abstract

This is the first report of a lumbar plexus injury as a result of spinal manipulation. The 39-year-old female patient reported right lower limb pain after receiving a deep massage and spinal manipulation. The manipulation including back hyperextension had been done in a prone position 4 months before our visit. At that time she felt sudden onset pain in the low back radiating to the posteromedial side of right knee. The patient had numbness in the medial side of the knee and leg. Muscle force of hip flexion and knee extension as well as the muscle stretch reflex of right patella were reduced. Lumbosacral X-ray and MRI were normal. However, electrodiagnostic study revealed unobtainable sensory response of right sapheneus and lateral femoral cutaneous nerve as well as decreased amplitude of right quadriceps motor response. Needle electromyography revealed denervation potential in the vastus medialis, adductor longus and illiopsoas muscles compatible with severe partial axonal type right lumbar plexus injury. Considering potentially serious complications of manipulation and massage, these techniques should be performed only by expert hands.