2. Characteristics
Low incidence: Rarely reported lesions, witch, if
posttraumatic, may remain undiagnosed because of
the variable destination of the patients in emergency
Difficult level diagnosis: Patients witch different
parenchimal or visceral lesions, with different
problems witch hinder motility (And frequently
affected by severe pain)
Difficult surgical treatment:
Analogous lesions in the brachial plexus are
normally treated, and results are quite well known.
In this anatomical district surgical approach is not
so comfortable and familiar
www.hgiocoli.com
3. Etiology
Traumatic Events
• Herniorrhaphy
Obstetrical trauma • Appendectomy
• Hysterectomy
Surgery • Lumbar sympatectomy
• Lateral approach to the
Abdominal surgery spine
Gynecological procedures
Tumors
Intrapelvic
Terminal branches
www.hgiocoli.com
4. Anatomy
Lumbar Plexus
Spinal roots L2, L3, and L4
(L1 and L5)
Located in the corner
between vertebral bodies
and lateral apophisis
Covered by
Ascending iliac and cava
veins, and by psoas muscle
By aorta and common iliac
arteries on the right side
By iliac arterial and venous
plexuses on the left
www.hgiocoli.com
6. Anatomy
Sacral Plexus
Spinal roots L5, S1,
and L2 (L4)
Lies on the sacro iliac
junction
Medial to psoas muscle
between it and the column
Hypogastric artery
intermigles the nerve trunks
and asending veins cover
the plexus
The lumbosacral trunk is
given by components from
L4 and from L5
www.hgiocoli.com
8. Surgical Techniques
Anterior: extraperitoneal
Lateral: extraperitoneal
Anterior: transperitoneal
Posterior: sacrectomy
In some cases is impossible to access to the
more proximal sciatic nerve, the bony and
ligamentous rim of the greater sciatic notch can
be nibbled or drilled away to gain access
www.hgiocoli.com
