Anatomy and computed tomography of the normal lumbosacral plexus

Abstract

The main nerves of the pelvis and lower limbs arise from the lumbar and sacral plexuses. These nerves can be affected by any of a large number of pathologic processes that occur in the paravertebral and pelvic regions. Understanding of the neurological findings related to paravertebral and pelvic pathology needs complete and accurate knowledge of the anatomy of these regions. The axial transverse sections of computed tomography give perfect visualisation of the anatomy of osseous, muscular, and vascular structures of the vertebral and paravertebral area and pelvic walls. Visualisation of the nerves in this regions is much more difficult, because direct demonstration of nervous structures by computed tomography is usually impossible. To be able to identify components of the lumbosacral plexus on axial CT sections the radiologist has to know the location of the nervous structures and the relationships of these structures to vascular, muscular and osseous structures which are easily demonstrated.

Continuous Psoas Compartment Blocks After Major Orthopedic Surgery in Children: A Prospective Computed Tomographic Scan and Clinical Studies

“…The new landmarks permitted correct placement of the CPCB catheter in 15 consecutive children, facilitating and ensuring the safety of CPCB catheter insertion. In the literature on LP anatomy in adults (8,14,15), the point of puncture described by Winnie et al (6) can be overly lateral, and recognizing this problem, the authors recommended proceeding with the needle in a slightly medial direction during the puncture, bringing the tip closer to the spine. However, a more medially oriented needle can result in bilateral anesthesia or spinal anesthesia, even if the physician uses a nerve stimulator for guidance (16).…”

The Relationship Between Lumbosacral Plexopathy and Pelvic Fractures

“…In contrast, the lower LS plexus quadrant is located between the greater sciatic notch and the piriformis muscle and therefore may be susceptible to highspeed deceleration injuries. 14,15 Two factors relevant to proximal sciatic neuropathy may explain why the posterior quadrant is more susceptible to injury than the anterior quadrant of the lower LS plexus. The first factor is the funicular arrangement of the two quadrants.…”

Review of the principal extra spinal pathologies causing sciatica and new MRI approaches

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