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Contents
1 Spinal Nerves
2 The Branches
2.1 Superior Gluteal Nerve
2.2 Inferior Gluteal Nerve
2.3 Sciatic Nerve
2.4 Posterior Femoral Cutaneous
2.5 Pudendal Nerve
2.6 Other Branches
3 Clinical Relevance – Lumbosacral Plexopathy
The sacral plexus is a network of nerve fibres that supplies the skin and muscles of the pelvis and
lower limb. It is located on the surface of the posterior pelvic wall, anterior to the piriformis muscle.
The plexus is formed by the anterior rami (divisions) of the sacral spinal nerves S1, S2, S3 and S4. It
also receives contributions from the lumbar spinal nerves L4 and L5.
In this article, we shall look at the anatomy of the sacral plexus – its formation and major branches.
Spinal Nerves
The spinal nerves S1 – S4 form the basis of the sacral plexus.
At each vertebral level, paired spinal nerves leave the spinal cord via the intervertebral foramina of
the vertebral column.
Each nerve then divides into anterior and posterior nerve fibres. The sacral plexus begins as
the anterior fibres of the spinal nerves S1, S2, S3, and S4. They are joined by the 4th and 5th lumbar
roots, which combine to form the lumbosacral trunk. This descends into the pelvis to meet the
sacral roots as they emerge from the spinal cord.
Fig 1.0 – The spinal cord outflow at each vertebral level. The anterior rami of vertebral levels S1-S4 make up the roots of the sacral plexus.
The Branches
The anterior rami of the S1-S4 spinal roots (and the lumbosacral trunk) divide into several cords.
These cords then combine together to form the five major peripheral nerves of the sacral plexus.
(Note: In this article we shall include only brief notes on
Fig 1.1- The right lumbar plexus, and the left sacral
the function of these nerves – for more detailed
plexus.
information click on the title to visit their respective
pages)
Motor Functions: Innervates the gluteus minimus, gluteus medius and tensor fascia lata.
Fig 1.2 – Derivation of the superior gluteal nerve from the sacral plexus
It is accompanied by the inferior gluteal artery and vein for much of its course.
Sciatic Nerve
See more detailed information here
Motor Functions:
Sensory Functions:
For more details about the Common Fibular nerve, click here.
Sensory Functions: Innervates the skin on the posterior surface of the thigh and leg. Also
innervates the skin of the perineum.
Pudendal Nerve
This nerve leaves the pelvis via the greater sciatic foramen, then re-enters via the lesser sciatic
foramen. It moves anterosuperiorly along the lateral wall of the ischiorectal fossa, and terminates by
dividing into several branches.
Sensory Functions: Innervates the penis and the clitoris and most of the skin of the perineum.
(Tip – an easy way to remember the functions of the pudendal nerve is S2, S3, S4 keeps poo off the
floor!)
Fig 1.6 – Derivation of the pudendal nerve from the sacral plexus
Other Branches
In addition to the five major nerves of the sacral plexus, there are a number of smaller branches.
These tend to be nerves that directly supplying muscles (with the exception of the perforating
cutaneous nerve, which supplies the skin over the inferior gluteal region and the pelvic splanchnic
nerves, which innervate the abdominal viscera):
• Nerve to piriformis
One of the main causes of lumbosacral plexopathy is diabetic amyotrophy, also known
as lumbosacral radioplexus neurophagy. In this condition, the high blood sugar levels damage
the nerves. Idiopathic plexopathy is another cause, being the lumbosacral equivalent of
Parsonage-Turner syndrome (which affects the brachial plexus). Tumours and other local
invasions can cause the plexopathy due to the compression of the plexus.
Treatment depends on what is causing the symptoms. For tumours and space-occupying
lesions, they should be removed if possible. For diabetic and idiopathic causes, treatment with
high-dose corticosteroids can be useful.
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