To explore the clinical characteristics of complex lumbosacral radiculopathy in order to enhance the understanding of its complex etiology.

A retrospective study was conducted, collecting data from 11 patients with clearly diagnosed lumbosacral radiculopathy who were treated at Fuxing Hospital Affiliated to Capital Medical University and Beijing Tsinghua Changgung Hospital from September 2018 to January 2025. Demographic information, clinical baseline data, laboratory tests, neurophysiological studies, imaging data, and surgical procedures were systematically reviewed. The clinical features were summarized, and the diagnostic and treatment processes were analyzed.

Among the 11 patients, 3 were male and 8 were female, with ages ranging from 29 to 71 years and disease durations from 20 days to 5 years. The initial symptom in all patients was unilateral or asymmetric low back pain, gradually progressing to unilateral/bilateral focal lower limb pain. As the disease advanced, varying degrees of muscle weakness and atrophy developed, with severe cases leading to an inability to walk independently and urinary/fecal dysfunction. All patients were initially diagnosed with lumbar degenerative disease, but symptoms worsened despite symptomatic treatment. The final diagnoses revealed complex etiologies of lumbosacral radiculopathy. Among the 11 patients, 2 had Brucellosis infection, 2 had tuberculosis infection, and 1 had herpes zoster virus infection. These 5 patients showed significant clinical improvement after active anti-Brucellosis, anti-tuberculosis, and antiviral treatments. One patient was pathologically confirmed to have a myxopapillary ependymoma, with a good prognosis after surgical resection. One patient had lumbosacral radiculopathy due to local infiltration from recurrent rectal cancer, with a poor prognosis. One patient developed lumbosacral radiculopathy after radiotherapy for cervical cancer. Three patients were diagnosed with hematologic diseases via bone marrow biopsy: 1 with mantle cell lymphoma, 1 with chronic lymphocytic leukemia, and 1 with acute lymphocytic leukemia.

Lumbosacral radiculopathy is a common clinical condition with diverse symptoms and complex etiologies. While lumbar degenerative disease is a common cause, complex and rare causes include infections, hematologic malignancies, pelvic tumors, and post-radiation injury. For patients with lumbosacral pain who do not improve or even worsen after conventional treatment, the possibility of complex lumbosacral radiculopathy should be considered. Increasing the use of necessary auxiliary examinations to improve the understanding of complex etiologies is crucial for patient treatment and prognosis.