Intrapartum lesions to the lumbar portion of the lumbosacral plexus: an anatomical review

ABSTRACT

The lumbosacral plexus is formed by the ventral rami of L2-S3 and provides sensory and motor branches to the lower extremity. The spatial orientation of the lumbar portion of the plexus above the pelvic brim leaves it particularly susceptible to intrapartum injury by the fetal head. Such lesions are subdivided into two groups upper lumbar plexus (L1-L4) and lumbosacral trunk (L4-L5). Given the root levels involved, upper lumbar plexus lesions produce symptoms suggestive of iliohypogastric, ilioinguinal, genitofemoral, femoral, and obturator neuropathies or L4 radiculopathies. Alternatively, involvement of the lumbosacral trunk can imitate a common fibular (peroneal) neuropathy or L5 radiculopathy. This symptomatic overlap with various neuropathies and radiculopathies, makes diagnosis of such lesions particularly challenging. To assist in the clinical diagnosis of intrapartum lumbosacral plexopathies, we provide an overview of the motor, sensory, and reflex deficits associated with such lesions and establish the clinical profile of such patients by presenting case studies from the literature of lumbosacral plexopathies. Only cases from the literature involving women who delivered via cesarean section are explored to isolate the presentation of these lesions from injuries related to birth trauma.Based on this overview, we offer differential diagnostic tools which can be utilized to aid in the identification and subsequent treatment of intrapartum lesions to the lumbar portion of the lumbosacral plexus

RESUMEN

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