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Background: Together with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach. Methods: A total of 260 lumbar regions from embalmed cadavers were utilized in this study. The specimens were dissected as per protocol and all nerves from the lumbar plexus were morphologically evaluated. Results: The most common variation of the iliohypogastric and ilioinguinal nerves was fusion of these two nerves (9.6%). Nearly in the half of the cases (48.1%) the genitofemoral nerve left the psoas major muscle already divided into the femoral and genital branches. The lateral femoral cutaneous nerve was the least variable one as it resembled its normal morphology in 95.0% of cases. Regarding the variant origins of the femoral nerve, there was a low formation outside the psoas major muscle in 3.8% of cases. The obturator nerve was not variable at its emergence point but frequently branched (40.4%) before entering the obturator canal. In addition to the proper femoral and obturator nerves, accessory nerves were present in 12.3% and 9.2% of cases, respectively. Conclusion: Nerves of the lumbar plexus frequently show atypical anatomy outside the psoas major muscle. The presented study provides a compendious information source of the possibly encountered neural variations during retroperitoneal access to different segments of the lumbar spine. [ABSTRACT FROM AUTHOR]

Aim and objective: This study aims to determine the level of origin, branching pattern, and exit in relation to the psoas major muscle of the lateral femoral cutaneous, and genitofemoral nerves. Additionally, we determine the intraabdominal course, relations, and branching pattern of these nerves. Materials and Methods: A total of twenty-four lateral femoral cutaneous, and genitofemoral nerves of the lumbar plexus were dissected. The level of origin, branching, and exits in relation to the psoas major muscle were carefully examined. Moreover, we noted each nerve's unique origin, course, branching pattern and their relations. All these observations were recorded through photography. Results: In 2 cases (8.33%), we found accessory lateral femoral cutaneous nerves. 4 cases (16.67%) showed that the genital and femoral branches of the genitofemoral nerve had separate origins. The present study observed rare variations in the genital branch's anatomical pattern and relations. Conclusion: To the best of our knowledge, this type of intraabdominal course and branching pattern in the genital branch of the genitofemoral and accessory lateral femoral cutaneous nerves have not been documented in any published data. Knowledge of anatomical variations in the course, branches, and their relations in the intraabdominal segments of the genitofemoral and lateral femoral cutaneous nerves is helpful for the proper clinical diagnosis and surgical procedures to avoid injuries and complications to the nerve. [ABSTRACT FROM AUTHOR]

Aim and objective: This study aims to determine the level of origin, branching pattern, and exit in relation to the psoas major muscle of the lateral femoral cutaneous, and genitofemoral nerves. Additionally, we determine the intraabdominal course, relations, and branching pattern of these nerves. Materials and Methods: A total of twenty-four lateral femoral cutaneous, and genitofemoral nerves of the lumbar plexus were dissected. The level of origin, branching, and exits in relation to the psoas major muscle were carefully examined. Moreover, we noted each nerve's unique origin, course, branching pattern and their relations. All these observations were recorded through photography. Results: In 2 cases (8.33%), we found accessory lateral femoral cutaneous nerves. 4 cases (16.67%) showed that the genital and femoral branches of the genitofemoral nerve had separate origins. The present study observed rare variations in the genital branch’s anatomical pattern and relations. Conclusion: To the best of our knowledge, this type of intraabdominal course and branching pattern in the genital branch of the genitofemoral and accessory lateral femoral cutaneous nerves have not been documented in any published data. Knowledge of anatomical variations in the course, branches, and their relations in the intraabdominal segments of the genitofemoral and lateral femoral cutaneous nerves is helpful for the proper clinical diagnosis and surgical procedures to avoid injuries and complications to the nerve.

Introduction: Anatomical variations of the nerves derived from the lumbar plexus are common and clinically valid. Therefore, this report aims to present the coexisting anatomical variations of the lateral femoral cutaneous and genitofemoral nerves. Case description: During routine dissection of an isolated male left lower limb (fixed in 10 % formalin solution), atypical arrangements of the lateral femoral cutaneous and genitofemoral nerves were found. The lateral femoral cutaneous nerve division level into anterior and posterior branches was high, above the inguinal ligament. Both branches passed beneath the inguinal ligament at the midpoint of the distance between the anterior superior iliac spine and the femoral artery. The anterior branch of the lateral femoral cutaneous nerve was better developed and had a greater diameter than the posterior branch. The femoral branch of the genitofemoral nerve was absent and partially replaced by the most medial branch derived from the anterior division of the lateral femoral cutaneous nerve. Conclusions: The lateral femoral cutaneous and genitofemoral nerves can show anatomic variability, which should be remembered during clinical assessments of nerve lesions and while performing surgical interventions.

Background: To describe the experience in the diagnostic process and treatment of patients with groin pain (GP) of neurological origin due to entrapment of the iliohypogastric (IH), ilioinguinal (IL) and genitofemoral (GF) nerves in a hip preservation clinic. Methods: Retrospective study of patients with GP of neurological origin confirmed with ultrasound-guided nerve block. Clinical outcomes were reported in 21 cases (age, 53.3 ± 15.9 years) treated with conservative treatment from January to December 2019, and in 9 patients (age 43.7 ± 14.6 years) who underwent neurectomy from January 2015 to December 2019. Pain intensity was assessed with a numerical rating scale (NRS) before starting the diagnostic process (Day 0) and at the end of follow-up. Results: All cases reported pain on groin palpation. Half of these cases also reported a positive FADIR test (flexion, adduction, internal rotation) (15/30). On day 0, the intensity of pain in cases treated with conservative treatment was severe in 19 patients (NRS 7–10) and moderate in 2 (NRS 4–6), with a median improvement of 7 points (interquartile range [IQR] 5.5–8.0) at the end of follow-up (p < 0.001). In neurectomy group, a similar improvement in pain severity was (Day 0: 9 points [IQR 8.0–9.0]; end of follow-up: 0 points [IQR: 0–2.0]; p = 0.002). At the end of the study, 17/21 patients with conservative treatment and 7/9 with neurectomy were pain free or with mild pain (NRS < 3). Conclusions: In cases with PG of neurological origin, there is a high frequency of false positives in the FADIR test. Our findings suggest that neurectomy is a treatment option for patients in whom conservative treatment fails, providing significant pain relief. [ABSTRACT FROM AUTHOR]

Genitofemoral neuralgia is an uncommon pain disorder that could be resistant to conventional treatment. A 78-year-old woman with refractory right genitofemoral neuralgia was treated with BoNT/A subcutaneous injections; the treatment was performed three times with significant pain improvement, although temporary, and without adverse events. BoNT/A may be a promising alternative intervention in the setting of genitofemoral neuralgia refractory to oral and/or topical treatment. [ABSTRACT FROM AUTHOR]

Genitofemoral neuralgia is an uncommon pain disorder that could be resistant to conventional treatment. A 78-year-old woman with refractory right genitofemoral neuralgia was treated with BoNT/A subcutaneous injections; the treatment was performed three times with significant pain improvement, although temporary, and without adverse events. BoNT/A may be a promising alternative intervention in the setting of genitofemoral neuralgia refractory to oral and/or topical treatment.

Chronic groin pain can be due to a variety of causes and is the most common complication of inguinal hernia repair surgery. The etiology of pain after inguinal hernia repair surgery is often multifactorial though injury to or scarring around the nerves in the operative region, namely the ilioinguinal nerve, genital branch of the genitofemoral nerve, and the iliohypogastric nerve, is thought to be a key factor in causing chronic post-operative hernia pain or inguinal neuralgia. Inguinal neuralgia is difficult to treat and requires a multidisciplinary approach. Radiologists play a key role in the management of these patients by providing accurate image-guided injections to alleviate patient symptoms and identify the pain generator. Recently, ultrasound-guided microwave ablation has emerged as a safe technique, capable of providing durable pain relief in the majority of patients with this difficult to treat condition. The objectives of this paper are to review the complex nerve anatomy of the groin, discuss diagnostic ultrasound-guided nerve injection and patient selection for nerve ablation, and illustrate the microwave ablation technique used at our institution. [ABSTRACT FROM AUTHOR]

The genitofemoral nerve (GFN) presents with a variable course in nearly half of the population. This variation can be seen in its availability, course, and branching. Here, a notable case during a cadaveric dissection revealed an unusually high bifurcation of the GFN on the left side, contrasting with the typical bifurcation observed on the right. This divergence was highlighted using colored markers to aid educational visualization, facilitating a comprehensive learning experience about the nerve's variability and its functional implications, such as the cremasteric reflex. Embryologically, these variations stem from the migratory paths of myotomes during development, influenced by extrinsic signals and growth factors. Despite the high incidence of anatomical variability, the muscular structure remains consistent, suggesting that the nerve's formation is more susceptible to developmental shifts than the muscles it innervates. Clinically, understanding GFN variations is crucial due to the nerve's involvement in conditions like genitofemoral neuropathy, which can arise from surgical procedures. Accurate knowledge of these variations aids in precise diagnostic and therapeutic interventions, reducing complications, and enhancing patient outcomes in lower abdominal and groin surgeries. However, further research is needed to elucidate the exact embryological and genetic underpinnings of these variations., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sahoo et al.)

Background Ilioinguinal, iliohypogastric, and genitofemoral nerves are together known as “border nerves” of the lumbar plexus. Aim of this study was to find out the variations in formation and branching pattern of these nerves and correlate with their clinical relevance. Materials and Methods For this study 30 formaldehyde preserved cadavers were used, and the nerves were studied on both the sides, thus making the sample size of 60. Results Iliohypogastric nerve was absent in 6.6% and double in 1.6%. It was prefixed with a twig from T12 in 6.6% and had origin from both L1 and L2 in 1.6%. The ilioinguinal nerve was absent in 3.3% and double in 3.3%. The genitofemoral nerve exhibited a large number of variations. It was absent in 1.6%. Early division of the nerve prior to emergence from the psoas major muscle was noticed in 13.3%, and early division soon after emergence from the muscle was noted in 3.3%. In one cadaver, on one side, genital branch was absent, and it continued as femoral branch only. In another cadaver, the nerve continued as genital branch only. In two other cases, genital and femoral branches were seen to arise separately from the lumbar plexus. The nerve had its origin from L1 and L2 in 25%, L2 and L3 in 25%, L1 in 3.3%, L2 in 46.66%, and L3 in 1.6% of the cases. Conclusion Knowledge of these variations would be of immense help during surgical approach and giving nerve block for anesthesia and postoperative analgesia in this region.

• Genitofemoral nerve motor conduction time and cremasteric reflex are useful for assessment of inguinal hernia complications. • Transcranial magnetic stimulation elicits a descending motor response in the cremaster muscle (CM), although its voluntary control is not essential. • Sacrolumbar intersegmental reflex circuit and CM activity are useful for evaluating ejaculatory dysfunction. Human research on the cremaster muscle (CM), cremasteric reflex (CMR) and genitofemoral nerve (GFN) and reports on their clinical applications using electrophysiological and histological techniques are rare. We aimed to present a detailed review of the human CM and CMR based on our earlier publications and relevant literature. Electromyography (EMG) of the CM was recorded using disposable needle electrodes. CMR was obtained with tactile and/or electrical stimulation of the inner thigh. Transcranial magnetic stimulation (TMS) and magnetic stimulation of the upper lumbar roots were applied; GFN was stimulated using a surface electrode at the anterior superior iliac spine. CM striated fibers comprised multiple motor end plates. CM needle EMG results were similar to those of the limb muscles in chronic neurogenic disorders. TMS produced clear-cut evoked motor responses from CM. GFN motor conduction time to CM was absent or delayed in patients with inguinal hernia. EMG of CM was abnormal in 40% of patients with premature ejaculation. CM is different from other skeletal muscles both morphologically and physiologically. Intersegmental sacrolumbar reflexes are useful for evaluating ejaculatory dysfunction. CM is an important muscle for testis thermoregulation and sexual reflexes. Neurophysiological techniques are available for physiological and clinical studies. [ABSTRACT FROM AUTHOR]

Postoperative groin and thigh dysesthesias are known potential sequelae of minimally invasive lateral lumbar interbody fusions (LLIF). Injury to the genitofemoral nerve (GFN) may play some role in occurrence of these symptoms. Our goals were to determine a precise, reproducible manner of diagnosing postoperative GFN dysfunction, and to evaluate an endoscopic assisted LLIF as a viable method of identifying and protecting the GFN. We performed a retrospective review of 21 consecutive patients undergoing endoscopic-assisted LLIF at 33 disc levels. CO2 insufflation was performed through a laterally placed incision. The GFN was visualized over the surface of the psoas muscle and mobilized away from the surgical corridor. The rest of the surgery proceeded as previously described (Ozgur et al., 2006 [18]). The presence of GFN injury was defined as a subjective sense of pain, numbness, or dysesthesias in the GFN territory, or an objective decrease in sensation in the ipsilateral femoral triangle. The patients were followed for an average of 15.1 months (range of 2 to 41 months). The GFN was identified in the surgical corridor in seven cases. In 6 patients, the nerve was easily mobilized. In one patient, intramuscular dissection was required. This patient experienced temporary diminished sensation in the territory of the GFN. Therefore, our rate of transient genitofemoral neuropathy was 4.8%, and there were no cases of permanent nerve damage. This paper further confirms the specific sensory distribution of the femoral branch of the GFN and also provides in vivo evidence that the vulnerably situated GFN can be safely mobilized and avoided using an endoscopic direct look.

Study Design: This is a cross-sectional study.Objective: To investigate the oblique corridor to the L1-S1 intervertebral disc space between the psoas muscle and the great vessels in cadaveric specimens bilaterally and the location of genitofemoral nerve and the diaphragmatic crura relative to the oblique corridor.Summary Of Background Data: Although use of oblique lumbar interbody fusion is rapidly expanding, the morphometric data related to the procedure are limited.Methods: Twelve fresh-frozen full-torso cadaveric specimens were dissected to examine the oblique corridor to access the L1-S1 space in a static state and with mild retraction of the psoas. The level at which the genitofemoral nerve pierces from the psoas major and the diaphragmatic crura originate from the lumbar vertebral body was also investigated.Results: The mean width of oblique corridor in the static state and with mild psoas retraction, respectively, were as follows: on the right side: (L1-2) 13.33 and 16.75 mm; (L2-3) 15.42 and 21.42 mm; (L3-4) 16.58 and 22.67 mm; (L4-5) 12.75 and 21.17 mm; (L5-S1) 5.92 and 12.00 mm; on the left side: (L1-2) 16.75 and 19.67 mm; (L2-3) 18.50 and 25.33 mm; (L3-4) 20.58 and 28.00 mm; (L4-5) 18.17 and 26.08 mm; and (L5-S1) 5.83 and 12.00 mm. The level at which the genitofemoral nerve pierces from the psoas major was between L2 and L4. The diaphragmatic crura originates from L1 to L3.Conclusion: The oblique corridor allows access to the L1-L5 discs from both sides, but it is larger on the left side. The corridor between the iliac vessels and the psoas for L5-S1 is difficult to be applied clinically. Mild psoas retraction can moderately enlarge the oblique corridor. The genitofemoral nerve and diaphragmatic crura may be encountered in this approach and should be carefully observed.Level Of Evidence: 5. [ABSTRACT FROM AUTHOR]

Background: Variation in origin and branching pattern of genitofemoral nerve are common. These anatomical variations important for anatomists, clinicians, anesthetics and surgeons for avoid unexpected complication. Material And Method: 25 cadavers dissected in last 3 year. Result: in this study 20% cadavers found in genitofemoral nerve split near to the root L1-L2 while 4% cadavers found genitofemoral nerve derived from the root L2. Conclusion: In this study we found significant variation in genitofemoral nerve which is important for anatomists for academic purpose and also for surgeon to prevent iatrogenic nerve Injury. [ABSTRACT FROM AUTHOR]

Orchialgia is a common urologic complaint with a myriad of etiologies. Workup for orchialgia requires a broad differential diagnosis and a thorough understanding of relevant anatomy. We report the case of a 43-year-old man who presented to a urologist with right testicular pain. Following a negative workup, the patient received a spermatic cord block for therapeutic and diagnostic purposes. Two months after the block, the patient returned with new complaints of ipsilateral inner thigh paresthesias, suggesting a pathologic process proximal to the genital branch of the genitofemoral nerve. A subsequent MRI of the lumbosacral spine revealed a paraspinal mass involving nerve roots at L1-2. We highlight the utility of the spermatic cord block and its role in the diagnosis of a paraspinal tumor as an uncommon cause of orchialgia. [ABSTRACT FROM AUTHOR]

In February, 2017, while doing the routine dissection inside the abdomen of a 70 year old male cadaver, in the department of anatomy, North Bengal Medical College, West Bengal, several variations were found in the arterial supply of the abdominal viscera and branches of lumbar plexus. There were double right colic artery (emerging from the superior mesenteric artery). An accessory renal artery reached the lower pole of the right kidney after emerging from the abdominal aorta from its right side and there were double renal veins in the same kidney. Moreover, the genitofemoral nerve on the left side divided into genital and femoral branches in the upper one-third of the psoas major muscle and on the right side, common trunk (the ventral ramus of L1) emerged through the psoas major muscle to bifurcate into the iliohypogastric and ilioinguinal nerves. This case report will enhance our knowledge in gross anatomy and will be of help for surgical, radiological or other clinical interventions in abdomen. [ABSTRACT FROM AUTHOR]

Far lateral interbody fusion is a minimally invasive operating technique. However, the incidence of postoperative neurological complications is high, and some scholars question its safety. This study describes the neuroanatomical features and spatial orientation within the psoas major. Ten embalmed male cadavers were selected and the left psoas major was dissected. Subsequently, the area between the anterior and the posterior edges of the vertebral body was divided into three equal zones. The nerves' distribution, number, and spatial orientation of the L1/2 to L4/5 intervertebral discs were examined. A caliper was used to measure the diameter of the nerve. The safety zone of the L1/2 intervertebral disc level is located in zone I and II, the relative safe zones of the L2/3 and L4/5 intervertebral discs are located in zone II, and the safety zone of the L3/4 intervertebral disc level is located in the caudal side of zone II. The genitofemoral nerve exits the psoas major in a co-trunk or two-branch pattern, and its exit point was distributed between the L3 and L4 vertebral bodies, mainly at the L3/4 intervertebral disc level. The sympathetic ganglia in the psoas major appeared only in zone I at the L2/3 intervertebral disc level. This is a systematic anatomical study that describes the nerves of the psoas major. Spine surgeons can use this study-which consists of important clinical implications-for preoperative planning, and thus, reduce the risk of nerve injury during surgery., (© 2023 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)