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Abstract Objective To present a group of anatomical findings that may have clinical significance. Design This study is an anatomical case report of combined lumbo-pelvic peripheral nerve and muscular variants. Setting University anatomy laboratory. Participants One cadaveric specimen. Methods During routine cadaveric dissection for a graduate teaching program, unilateral femoral and bilateral sciatic nerve variants were observed in relation to the iliacus and piriformis muscle, respectively. Further dissection of both the femoral nerve and accessory slip of iliacus muscle was performed to fully expose their anatomy. Results Piercing of the femoral nerve by an accessory iliacus muscle combined with wide variations in sciatic nerve and piriformis muscle presentations may have clinical significance. Conclusions Combined femoral and sciatic nerve variants should be considered when treatment for a lumbar disc herniation is refractory to care despite positive orthopedic testing.