Anatomical landmarks for the lumbar plexus on the posterior abdominal wall

Object. Reports describing surgical landmarks with which to identify the branches of the lumbar plexus found on the posterior abdominal wall are lacking in the English-language literature. Methods. The authors examined 22 sides from six female and five male cadavers. Measurements were made between the branches of the lumbar plexus and various bone landmarks such as the midline vertebral bodies, supracristal plane—a horizontal line connecting the superior-most aspect of the left and right iliac crests approximating the L4–5 vertebrae—and anterior superior iliac spine (ASIS). The mean distances from the midline and as they emerged through or lateral to the psoas major muscle to the subcostal, iliohypogastric, ilioinguinal, lateral femoral cutaneous, genitofemoral, and femoral nerves, were 5.5, 6, 6.5, 6, 4.5, and 4.5 cm, respectively. At a vertical line through the midpoint between the ASIS and the midline, the subcostal, iliohypogastric, and ilioinguinal nerves were superior to the supracristal plane at mean distances of 8, 4, and 5 cm, respectively. Inferior to the supracristal plane and in a vertical line through a midpoint between the ASIS and the midline, the lateral femoral and femoral nerves were found to have mean distances of 5 and 5.5 cm, respectively. The obturator nerve had a mean distance of 3 cm lateral to the midline. Additionally, the lateral femoral cutaneous nerve had a mean distance of 1.5 cm inferomedial to the ASIS. Conclusions. A good working knowledge of the locations and anatomy of the nerves of the lumbar plexus on the posterior abdominal wall is necessary for the surgeon who operates in this region. The measurements provided herein will aid the surgeon who wishes to expose or avoid these nerves, thus precluding injury.