The lateral femoral cutaneous nerve arises from L2-L3 and crosses the iliacus muscle obliquely, passing under or through the inguinal ligament medial to the anterior superior iliac spine. At its lumbar plexus origin it is vulnerable to retroperitoneal injury.
The lateral femoral cutaneous nerve at its lumbar origin is injured by retroperitoneal haematoma, psoas abscess, and during LLIF and retroperitoneal approaches. Meralgia paresthetica — entrapment most commonly at the ASIS — produces lateral thigh burning and numbness. The lumbar origin injury produces a more proximal pattern with possible hip flexor involvement. EMG distinguishes lumbar origin from inguinal ligament entrapment.
Lateral femoral cutaneous nerve injury at its L2-L3 lumbar origin from retroperitoneal pathology producing lateral thigh burning and numbness, distinguished from inguinal ligament entrapment by associated lumbar plexus involvement on EMG.
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