Surgical Approaches to the Lumbosacral Plexus

Abstract

Abstract The lumbosacral plexus and its branches extend from the retroperitoneal space to the buttock area, thigh, leg, and foot. Surgical exposures depend on the indication and pathology. Nerve entrapments can require piriformis release in the buttock, fibular nerve decompression at the fibular neck, tibial nerve release under the soleal arch, or tarsal tunnel release at the ankle. Nerve trauma can be treated by direct suturing if it can be performed without tension, grafting including autograft or allograft, or nerve transfer. Common nerve sheath tumors including neurofibroma and schwannoma can be encountered sporadically or as part of neurofibromatosis 1, neurofibromatosis 2, or schwannomatosis. Complications depend on the approach but in general terms include wound infection, hematoma, or nerve injury. The latter can cause pain, paralysis, or loss of sensation. Retroperitoneal approaches have the added risk of bowel perforation and ureteric or vascular injuries.