Anatomy of the Anterior Sacroiliac Joint With Reference to Lumbosacral Nerves

There are no detailed descriptions of the neural structures that may be seen during surgical interventions of the pelvis. Anatomic dissections were performed to see which nerves are endangered in approaches to the anterior sacroiliac joint for plate fixations. Sixty cadavers were dissected bilaterally. Fifty-one were male and nine were female. L4 and L5 nerve roots were followed along the sacroiliac joint from the intervertebral foramen to the entrance into the lesser pelvis. Measurements were made between the nerves and sacroiliac joint from the proximal end of the joint to the pelvic brim. The L4 nerve root and the lumbosacral trunk (and not the L5 nerve root) were the nerves most susceptible to injury because of their course and proximity to the sacroiliac joint. As a result, during the anterior approach and fixation of the sacroiliac joint with plates, extreme care should be taken to identify the L4 nerve root or lumbosacral trunk or both at the anteroinferior third of the joint because the distance between the nerve and the joint is less than 1 cm.