The ilioinguinal nerve arises from L1 (with T12 contribution) just below the iliohypogastric nerve at the lumbar plexus level, emerging from the lateral psoas border and coursing on the quadratus lumborum surface before entering the inguinal canal. At the lumbar level it is vulnerable to direct posterior lumbar surgical injury.
The ilioinguinal nerve at its lumbar origin is at risk during retroperitoneal approaches to the lumbar spine, LLIF procedures, and psoas muscle retraction. Injury at this level produces groin and medial thigh numbness and is distinguished from inguinal nerve injury at the canal level by the addition of scrotal or labial sensory loss. Nerve hydrodissection under ultrasound targets the nerve adjacent to the quadratus lumborum.
Groin and upper medial thigh numbness from ilioinguinal nerve injury at its lumbar plexus origin during retroperitoneal or posterior lumbar surgery, distinct from more distal inguinal canal entrapment.
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