Superior Hypogastric Plexus and Its Surgical Implications During Spine Surgery: A Review

The superior hypogastric plexus (SHP) is a complex nervous collection located at the lumbosacral region below the level of the aortic bifurcation. As a part of the autonomic nervous system, it is an extension of the preaortic plexuses and continues bilaterally as the hypogastric nerves that ultimately contribute to the inferior hypogastric plexus. Although commonly described as a plexiform structure, several morphologic variations exist. Damage to the SHP can occur during anterior and anterolateral approaches to the lumbosacral spine leading to dysfunction of the abdominopelvic viscera. Visceral afferents travel in the SHP and are responsible for transmitting pain. Management therapies such as SHP blockade or presacral neurectomy can reduce pelvic pain caused by cancer and nonmalignant etiologies. This review highlights some of the recent findings regarding the nature of the SHP.