NEUROVASCULAR ANATOMY LUMBAR SPINE

LUMBAR PLEXUS Formed from the anterior rami of L1-3 and most of the anterior ramus of L4. Often remembered with the mnemonic I, I Get Laid on Fridays! Nerve Iliohypogastric Nerve root L1 Motor function Internal oblique and transversus abdominis Internal oblique and transversus abdominis Genital branch cremaster (males!) -Sensory function Posterolateral gluteal skin and pubis region. Upper medial thigh and root of penis/ant scrotum or mons pubis and labium majus. Genital skin of ant scrotum or mons pubis and labium majous. Femoral upper anterior thigh. Antero-lateral thigh to the knee. Medial thigh.

Ilio-inguinal

L1

Genitofemoral

L1, L2

Lateral cutaneous nerve of the thigh Obturator

L2, L3

L2 L4

Femoral

L2 L4

Obt externus, pectineus and adductors. Iliacus, ectineus and ant. Compartment thigh muscles

Anterior thigh and medial surface of leg.

LUMBAR PLEXUS NERVES AND PSOAS Genitofemoral n. travels within psoas major and then deep to the ureters. Lateral cut. n. of the thigh passes through psoas and over iliacus. Obturator n. descends within psoas, emerging near the pelvic brim. Femoral n. also descends through psoas, and then continues between the lateral border of psoas and the anterior surface of iliacus. N.B. The ilio-nerves do not pass through psoas, but cross quadratus lumborum instead.

SUPPLY TO LUMBAR REGION Posterior branches/rami of spinal nerves supply the intrinsic muscles of the back and the skin. Dermatome T12 is around the level of the iliac crest.

VENOUS DRAINAGE The inferior vena cava travels alongside the aorta (to the right of it) as the main route of venous blood from the lower extremities. The ascending lumbar veins (paired, one on either side of the vertebral bodies) also carry venous blood and become the azygos veins at T12, when they are joined by the subcostal veins. The azygos veins provide alternative/additional routes for venous drainage. BATSONS PLEXUS A valveless network of veins that connect the deep pelvic and thoracic veins to the internal vertebral venous plexuses. These IVV plexuses lie within the vertebral canal, two on either side of the PLL and two anterior to the vertebral arches. These form a network around the foramen magnum, which contributes to the vertebral veins. Batsons Plexus is a means for metastasis to spread from the pelvis to the vertebrae or further up. BLOOD SUPPLY TO THE CORD The anterior spinal artery is supplied by the lumbar arteries, iliolumbar artery and lateral sacral arteries in the lumbar region. The iliolumbar and lat. sacral arteries are branches of the internal iliac artery. The lumbar arteries are shown on the diagram below.

ARTERIAL SUPPLY The aorta passes through the crura at T12, entering the lumbar region. It gives off branches to the kidneys, ureters, gonads, lumbar cord and mesentery/GIT. Normal diameter of the abdominal aorta is 2 3 cm. Aortic diameter >3cm is considered an aneurysm but surgery is often not indicated unless it is >5.5 cm. The aorta bifurcates at L4.