Bilateral Ischemic Lumbosacral Plexopathy after Proximal Aortic Surgery

In paraplegia after proximal aortic surgery, in addition to spinal cord ischemia, injuries to the plexuses and other peripheral nerves should be considered. Spinal cord ischemia—the most common etiology of paraplegia—can be caused by the occlusion of several radicular arteries resulting from aortic clamping. We report a case of bilateral ischemic lumbosacral plexopathy with a spared spinal cord occurring after proximal aortic surgery. A 76-year-old woman underwent aortic valve replacement with ascending aorta and total arch replacement, along with multiple hematoma evacuations. Postoperatively, she developed paraplegia with sensory deficits in the bilateral lower limbs. Spinal magnetic resonance imaging revealed no remarkable findings at any level of the spinal cord. In electrophysiological studies, the compound motor action potential and sensory nerve action potential of the bilateral lower extremities did not respond to stimuli; all examined muscles displayed abnormal spontaneous activities without motor unit action potentials. Based on these findings, a diagnosis of bilateral lumbosacral plexopathy was ultimately made.