Inervasi Lumbal

YOSEPH A. N.
13.144
FKUPNVJ 2013

Lumbal
PLEXUS LUMBAL

Fungsi Inervasi Lumbal

(L1) Iliohypogastric & Ilio-inguinal

Cabang utama L1 memanjang melewati pinggiran

lateral dari otot Psoas Mayor

Cabang utama ini bercabang lagi menjadi
iliohypogastric dan ilio-inguinal

Cabang Iliohipograstrik
Melewati bagian permukaan depan otot quadratus

lumborum, dan bagian belakang ginjal

Berfungsi motorik pada otot transversus abdominis
dan berlanjut lewat bagian depan sekeliling tubuh di
antara otot transversus abdominis dan otot oblique
internal
Lateral cutaneous branch (cabang lateral) yang
berada di atas iliac crest mempersarafi otot oblique
internal dan eksternal, serta mensuplai daerah
posterolateral kulit gluteus

Cabang Iliohipograstrik
Anterior cutaneous branch (cabang anterior)

berlanjut dari bagian depan, mempersarafi otot

oblique internal ke arah bawah tengah
Semakin dekat ke kulit, saraf memanjang pada
superfisial dari inguinal ring setelah melewati
aponeurosis pada otot oblique eksternal
Lalu mempersarafi bagian kulit pada regio pubis

Cabang Ilio-inguinal
Cabang ilio-inguinal berukuran lebih kecil dan

posisinya lebih posterior dari iliohypogastric

Jalur yang dilewati cabang ini lebih curam dari
iliohypogastric dan menyebrangi otot iliaka untuk
sampai ke iliac crest
Dekat bagian akhir anterior dari iliac crest, cabang
ini mempersarafi otot transversus abdominis, lalu
otot oblique internal, setelah itu memasuki inguinal
canal

Cabang Ilio-inguinal
Kemudian cabang ini melewati superficial inguinal

ring bersamaan dengan spermatic cord dan

menginervasi bagian selangkangan, akar penis, serta
permukaan depan scrotum pada pria, mons pubis
dan labium majus pada wanita

(L1 & L2) Genitofemoral Nerve

Berasal dari percabangan L1 dan L2
Berjalan ke arah bawah melewati otot psoas mayor

sampai bagian permukaan depannya

Kemudian turun di permukaan otot, pada bagian
retroperitoneal, melewati bagian belakang sampai
pada ureter
Biasanya terbagi menjadi cabang genital dan femoral

Cabang Genital
Cabang genital terus mengarah turun dan masuk

melewati kanal inguinal dan inguinal ring

Pada Pria, mempersarafi otot cremasteric dan
berakhir pada kulit bagian atas anterior dari skrotum
Pada Wanita, beriringan dengan ligamen uterus
dan berakhir pada kulit mons pubis dan labium
majus

Cabang Femoral
Cabang Femoral memanjang turun pada sisi

samping arteri iliaka eksterna dan melewati ligamen

inguinal bagian posterior, memasuki sarung femoral
lateral sampai ke arteri femoral
Mempersarafi kulit bagian anterior atas daerah
selangkangan

(L2 & L3) Lateral Cutaneous Nerve of Thigh

Berasal dari L2 and
Memanjang dari tepi lateral otot psoas mayor, curam

ke bawah melewati otot iliaka

Kemudian melewati bagian posterior sampai ke
ligamen inguinal dan memasuki daerah
selangkangan
Mempersarafi kulit daerah anterior dan lateral
selangkangan sampai pada lutut

(L2 L4) Obturator Nerve

Berasal dari percabangan L2 sampai L4
Ke arah bawah melewati otot psoas mayor, berjalan

terus melewati dinding lateral rongga pelvis dan

memasuki kanal obturator untuk mempersarafi
bagian medial daerah selangkangan

(L2 L4) Obturator Nerve

Pada kanal obturator, saraf ini terbagi menadi

cabang anterior dan posterior

Ketika memasuki daerah selangkangan, dua cabang
ini terbagi oleh otot obturator eksternus dan
adductor brevis, kedua cabang ini mempersarafi:

Cabang persendian paha

Cabang otot ke obturator externus, pectineus, adductor longus,
gracilis, adductor brevis, and adductor magnus
Cabang daerah medial selangkangan
Bersamaan dengan saraf saphenous, mempersarafi bagian atas
kaki dan persendian lutut

(L2 L4) Femoral Nerve

Percabangan dari L2 sampai L4
Cabang ke arah bawah melewati otot psoas mayor pada

bagian samping tepi bawah

Saraf femoral berada di antara tepi lateral psoas mayor
dan permukaan anterior otot iliaka, makin ke dalam
melewati bagian lateral arteri femoral dan melewati
bagian posterior dari ligamen inguinal, lalu memasuki
bagian depan dari selangkangan
Ketika memasuki daerah selangkangan, saraf ini terbagi
menjadi beberapa cabang
Saraf Saphenous mempersarafi permukaan medial kaki

Sakral
PLEXUS SAKRAL

Sciatic Nerve
The sciatic nerve is the largest nerve of the body and carries

contributions from L4 to S3. It:

forms on the anterior surface of the piriformis muscle and leaves the
pelvic cavity through the greater sciatic foramen inferior to piriformis
passes through the gluteal region into the thigh, where it divides into
its two major branches, the common fibular nerve (common peroneal
nerve) and the tibial nerve-dorsal divisions of L4, L5, S1, and S2 are
carried in the common fibular part of the nerve and the ventral
divisions of L4, L5, S1, S2, and S3 are carried in the tibial part
innervates muscles in the posterior compartment of the thigh and
muscles in the leg and foot
carries sensory fibers from the skin of the foot and lateral leg

Pudendal nerve
The pudendal nerve forms anteriorly to the lower part of

piriformis muscle from ventral divisions of S2 to S4. It:

leaves the pelvic cavity through the greater sciatic foramen, inferior
to the piriformis muscle, and enters the gluteal region
courses into the perineum by immediately passing around the
sacrospinous ligament, where the ligament joins the ischial spine,
and through the lesser sciatic foramen (this course takes the nerve
out of the pelvic cavity, around the peripheral attachment of the
pelvic floor, and into the perineum)
is accompanied throughout its course by the internal pudendal
vessels
innervates skin and skeletal muscles of the perineum, including the
external anal and external urethral sphincters

Other branches
The superior gluteal nerve, formed by branches from the

dorsal divisions of L4 to S1, leaves the pelvic cavity through the

greater sciatic foramen superior to piriformis muscle and supplies
muscles in the gluteal region-gluteus medius, gluteus
minimus, and tensor fasciae latae (tensor of fascia lata)
muscles
The inferior gluteal nerve, formed by branches from the
dorsal divisions of L5 to S2, leaves the pelvic cavity through the
greater sciatic foramen inferior to the piriformis muscle and
supplies the gluteus maximus, the largest muscle in the gluteal
region
Both superior and inferior gluteal nerves are accompanied by
corresponding arteries.

Other branches
The nerve to the obturator internus and the

associated superior gemellus muscle originates

from the ventral divisions of L5 to S2 and leaves the
pelvic cavity through the greater sciatic foramen
inferior to the piriformis muscle. Like the pudendal
nerve, it passes around the ischial spine and through
the lesser sciatic foramen to enter the perineum and
supply the obturator internus muscle from the
medial side of the muscle, inferior to the attachment
of the levator ani muscle.

Other branches
The nerve to the quadratus femoris muscle and

the inferior gemellus muscle, and the posterior

cutaneous nerve of the thigh (posterior
femoral cutaneous nerve) also leave the pelvic
cavity through the greater sciatic foramen inferior to
the piriformis muscle and course to muscles and
skin, respectively, in the lower limb.

Other branches
Unlike most of the other nerves originating from the

sacral plexus, which leave the pelvic cavity through

the greater sciatic foramen either above or below the
piriformis muscle, the perforating cutaneous
nerve leaves the pelvic cavity by penetrating directly
through the sacrotuberous ligament and then
courses to skin over the inferior aspect of the
buttocks.

Other branches
The nerve to the piriformis and a number of

small nerves to the levator ani and coccygeus

muscles originate from the sacral plexus and pass
directly into their target muscles without leaving the
pelvic cavity.

Other branches
The obturator nerve (L2 to L4) is a branch of the

lumbar plexus. It passes inferiorly along the

posterior abdominal wall within the psoas muscle,
emerges from the medial surface of the psoas, passes
posteriorly to the common iliac artery and medially
to the internal artery at the pelvic inlet, and then
courses along the lateral pelvic wall. It leaves the
pelvic cavity by traveling through the obturator canal
and supplies the adductor region of the thigh.

Coccygeal plexus
The small coccygeal plexus has a minor contribution

from S4 and is formed mainly by the anterior rami of

S5 and Co, which originate inferiorly to the pelvic
floor. They penetrate the coccygeus muscle to enter
the pelvic cavity and join with the anterior ramus of
S4 to form a single trunk, from which small
anococcygeal nerves originate. These nerves
penetrate the muscle and the overlying sacrospinous
and sacrotuberous ligaments and pass superficially
to innervate skin in the anal triangle of the perineum.

Autonomic nerve

Sympathetic Diagram
Thoracolumbar Outflow
All preganglionic fibers of sympathetic division arise from cell bodies
of preganglionic neurons located in spinal cord segments T1-L2
Preganglionic sympathetic neurons in grey matter of spinal cord
produces lateral horns

Sympathetic neurons leave spinal cord via the ventral root and passes
through white ramus communicans (rami communicantes) to enter
paravertebral ganglion (forms part of sympathetic trunk)

Once a preganglionic axon reaches a paravertebral ganglion it can......

Synapse with a post ganglionic neuron within the same ganglion

Ascend/descend within sympathetic trunk to synapse with another
paravertebral ganglion
Pass through the ganglion and emerge from the sympathetic chain
without synapsing

Sympathetic Diagram
Synapses in Paravertebral (sympathetic chain) Ganglion:

Postganglionic axons enter the ventral ramus of the joining spinal nerves via
communicating branches called gray rami communicantes
Preganglionic fiber serving head, neck, and thorax emerge from spinal cord
segments T1-T6 and ascend the sympathetic chain to synapse with
postganglionic neurons within cervical ganglia (inferior, middle, and
superior)

Superior cervical ganglion:

Stimulates dilator muscles of irises

Inhibits nasal and salivary glands
Stimulates copious sweating
Stimulates arrector pili muscle to contract
Causes blood vessel vasodilation
Provides branches to carotid body (oxygen sensor) and larynx & pharynx

Middle cervical ganglia - innervates heart and skin

Inferior cervical ganglia (stellate ganglion) innervates heart, aorta, dilates bronchioles,
constrict esophageal sphincter

Sympathetic Diagram
Synapses in Prevertebral (Collateral) Ganglion: Preganglionic fibers of T5-

L2 synapse in prevertebral ganglia. Fibers enter and leave without synapsing and
form several nerves collectively called splanchnic nerves (greater, lesser, and
lumbar)
Splanchnic nerves synapse at abdominal aortic plexus that clings to surface of
abdominal aorta
Synapses occur at ganglia of plexus:

Greater splanchnic nerve

Lesser splanchnic nerve

Superior mesenteric (via celiac) ganglion - innervates small intestine

Lumbar splanchnic nerve

Celiac ganglion - innervates stomach (decrease muscle activity/constricts pyloric sphincter), adrenal
medulla (secretes epinephrine/norepinephrine), liver (epinephrine stimulates liver to release glucose),
kidney (vasoconstriction, decrease urine output), intestine (decrease smooth muscle activity)

Inferior mesenteric ganglion - innervates large intestine

Lumbar splanchnic nerve

Hypogastric ganglion - innervates bladder and urethra (causes relaxation of smooth muscle of bladder wall
and constricts urethral sphincter/inhibits voiding), genitalia (causes ejaculation in males and vaginal
contractions in females)

Parsympathetic Diagram
(Craniosacral Division)
Oculomotor nerve (III)

Preganglionic fibers from oculomotor nuclei in the midbrain synapses in the

ciliary ganglion (in eye), postganglionic fiber innervates smooth muscle of eye

Pupil constriction and lens movement to cause focusing

Facial nerve (VII)

Preganglionic fibers from lacrimal nuclei in the pons synapses in the

pterygopalatine ganglia, postganglionic fiber innervates lacrimal glands of eye

Lubrication of eye and tear formation

Preganglonic fibers from superior salivatory nuclei in the pons synapses in the
submandibular ganglia, postganglionic fibers innervate submandibular and
sublingual salivary glands

Production of saliva and secretion of salivary enzymes

Glossopharyngeal nerve (IX)

Preganglionic fibers from the inferior salivary nuclei in the medulla synapses in
the otic ganglia, postganglionic fibers innervate the parotid salivary gland

Cranial Outflow

Parsympathetic Diagram
(Craniosacral Division)

Vagus nerve (X)

Preganglionic fibers from the dorsal motor nuclei of the

medulla synapses in terminal ganglia located within the walls
of the target organ

Intramural ganglia ....effects:

Heart -decreases/steadies heart rate and constricts coronary
veins
Lung - constricts bronchioles
Gall bladder - expel bile
Stomach - stimulates secretion of enzymes
Intestines - increase motility (peristalsis) and relaxes sphincters

Cranial Outflow

Parsympathetic Diagram
(Craniosacral Division)

Preganglionic fibers from lateral gray matter of

spinal cord in segments S2-S4 synapse in terminal

ganglia within walls of the target organ

Intramural ganglia....effects:

Distal large intestines - relaxes sphincters

Bladder - contraction of smooth muscle of bladder wall; relaxes
urethral sphincter - promotes voiding
Genitalia - causes penile and clitoral erection

Sacral Outflow

Referensi
Grays Anatomy for Students, 2nd ed., 2009
Snell, Richard S.: Clinical Anatomy by Regions, 9th

ed. 2012