The lumbar plexus is formed within the substance of psoas major from the ventral rami of L1-L4, giving rise to the iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator nerves. The lumbosacral trunk (L4-L5) connects it to the sacral plexus.
The lumbar plexus within psoas is at risk during LLIF (lateral lumbar interbody fusion) procedures, where psoas retraction injures plexus branches producing post-operative hip flexor weakness, anterior thigh numbness, and groin pain. Neuromonitoring during LLIF guides safe retraction. The femoral nerve is the largest and most clinically significant lumbar plexus branch.
Psoas retraction injury to the lumbar plexus during lateral lumbar interbody fusion producing anterior thigh numbness, hip flexor weakness, and groin pain, managed with neuromonitoring intraoperatively and physiotherapy post-operatively.
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