Top

Published in:

Open Access 01-12-2024 | Laminectomy | Case report

Conjoined lumbosacral nerve root: a case report

Authors: Yasutaka Takagi, Hiroshi Yamada, Hidehumi Ebara, Hiroyuki Hayashi, Hiroyuki Inatani, Kazu Toyooka, Akari Mori, Yoshiyuki Kitano, Yasuji Ryu, Aki Nakanami, Tetsutaro Yahata, Hiroyuki Tsuchiya

Published in: Journal of Medical Case Reports | Issue 1/2024

Abstract

Background

In patients with conjoined nerve roots, hemilaminectomy with sufficient exposure of the intervertebral foramen or lateral recess is required to prevent destabilization and ensure correct mobility of the lumbosacral spine. To the best of our knowledge, no case reports have detailed the long-term course of conjoined nerve roots after surgery.

Case presentation

We report the case of a 51-year-old Japanese man with a conjoined nerve root. The main symptoms were acute low back pain, radiating pain, and right leg muscle weakness. Partial laminectomy was performed with adequate exposure to the conjoined nerve root. The symptoms completely resolved immediately after surgery. However, the same symptoms recurred 7 years postoperatively. The nerve root was compressed because of foraminal stenosis resulting from L5–S disc degeneration. L5–S transforaminal lumbar interbody fusion was performed on the contralateral side because of an immobile conjoined nerve root. At 44 months after the second surgery, the patient had no low back pain or radiating pain, and the muscle weakness in the right leg had improved.

Conclusions

This is the first report of the long-term course of conjoined nerve root after partial laminectomy. When foraminal stenosis occurs after partial laminectomy, transforaminal lumbar interbody fusion from the contralateral side may be required because of an immobile conjoined nerve root.

Epstein JA, Carras R, Ferrar J, Hyman RA, Khan A. Conjoined lumbosacral nerve roots: management of herniated discs and lateral recess stenosis in patients with this anomaly. J Neurosurg. 1981;55:585–9. https://doi.org/10.3171/jns.1981.55.4.0585.CrossRefPubMed

Artico M, Carloia S, Piacentini M, Ferretti G, Dazzi M, Franchitto S, et al. Conjoined lumbosacral nerve roots: observations on three cases and review of the literature. Neurocirugia. 2006;17:54–9. https://doi.org/10.1016/s1130-1473(06)70370-0.CrossRefPubMed

Broom MJ. Congenital anomalies of the lumbosacral spine causing nerve root entrapment: the role of high resolution CT in diagnosis. Orthopedics. 1994;17:63–7. https://doi.org/10.3928/0147-7447-19940101-11.CrossRefPubMed

Aota Y, Saito Y, Yoshikawa K, Asada T, Kondo S, Watanabe K. Presurgical identification of extradural nerve root anomalies by coronal fat-suppressed magnetic resonance imaging: a report of six cases and a review of the literature. J Spinal Disord. 1997;10:167–75. https://doi.org/10.1097/00002517-199704000-00010.CrossRefPubMed

Scuderi GJ, Vaccaro AR, Brusovanik GV, Kwon BK, Berta SC. Conjoined lumbar nerve roots: a frequently underappreciated congenital abnormality. J Spinal Disord Tech. 2004;17:86–93. https://doi.org/10.1097/00024720-200404000-00002.CrossRefPubMed

Lightsey HM, Xiong GX, Schoenfeld AJ, Simpson AK. Microendoscopic decompression of conjoined lumbosacral nerve roots. BMJ Case Rep. 2022;15: e248680. https://doi.org/10.1136/bcr-2021-248680.CrossRefPubMed

Kuroki H, Nagai T. Conjoined nerve root in a patient with lumbar disc herniation accompanied by a lumbosacral spine anomaly: a case report. J Med Case Rep. 2023;17:82. https://doi.org/10.1186/s13256-022-03749-1.CrossRefPubMedPubMedCentral

White JG 3rd, Strait TA, Binkley JR, Hunter SE. Surgical treatment of 63 cases of conjoined nerve roots. J Neurosurg. 1982;56:114–7. https://doi.org/10.3171/jns.1982.56.1.0114.CrossRefPubMed

Postacchini F, Urso S, Ferro L. Lumbosacral nerve-root anomalies. J Bone Joint Surg Am. 1982;64:721–9. https://doi.org/10.2106/00004623-198264050-00009.CrossRefPubMed

10.

Neidre A, MacNab I. Anomalies of the lumbosacral nerve roots. Review of 16 cases and classification. Spine. 1983;8:294–9. https://doi.org/10.1097/00007632-198304000-00010.CrossRefPubMed

11.

Stambough JL, Balderston RA, Booth RE, Rothman RH. Surgical management of sciatica involving anomalous lumbar nerve roots. J Spinal Disord. 1988;1:111–4. https://doi.org/10.1097/00002517-198801020-00002.CrossRefPubMed

12.

Maiuri F, Gambardella A. Anomalies of the lumbosacral nerve roots. Neurol Res. 1989;11:130–5. https://doi.org/10.1080/01616412.1989.11739877.CrossRefPubMed

13.

Prestar FJ. Anomalies and malformations of lumbar spinal nerve roots. Minim Invasive Neurosurg. 1996;39:133–7. https://doi.org/10.1055/s-2008-1052233.CrossRefPubMed

14.

Taghipour M, Razmkon A, Hosseini K. Conjoined lumbosacral nerve roots: analysis of cases diagnosed intraoperatively. J Spinal Disord Tech. 2009;22:413–6. https://doi.org/10.1097/BSD.0b013e31818f00a0.CrossRefPubMed

15.

Song SJ, Lee JW, Choi JY, Hong SH, Kim NR, Kim KJ, et al. Imaging features suggestive of a conjoined nerve root on routine axial MRI. Skeletal Radiol. 2008;37:133–8. https://doi.org/10.1007/s00256-007-0403-6.CrossRefPubMed

16.

Sharma A, Singh V, Agrawal R, Mangale N, Deepak P, Savla J, et al. 2021. Conjoint nerve root an intraoperative challenge in minimally invasive tubular discectomy. Asian Spine J. 15: 545–9. https://doi.org/10.31616/asj.2020.0250

17.

Engar C, Wadhwa V, Weinberg B, Chhabra A. Conjoined lumbosacral nerve roots: direct demonstration on MR neurography. Clin Imaging. 2014;38:892–4. https://doi.org/10.1016/j.clinimag.2014.07.009.CrossRefPubMed

18.

Heo DH, Kim SW, Chang HH, Park CK. Usefulness of oblique lumbar magnetic resonance imaging for nerve root anomalies and extraforaminal entrapment lesions. Asian Spine J. 2018;12:423–7. https://doi.org/10.4184/asj.2018.12.3.423.CrossRefPubMedPubMedCentral

Title: Conjoined lumbosacral nerve root: a case report
Authors: Yasutaka Takagi
Hiroshi Yamada
Hidehumi Ebara
Hiroyuki Hayashi
Hiroyuki Inatani
Kazu Toyooka
Akari Mori
Yoshiyuki Kitano
Yasuji Ryu
Aki Nakanami
Tetsutaro Yahata
Hiroyuki Tsuchiya
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Laminectomy
Disc Herniation
Hemilaminectomy
Published in: Journal of Medical Case Reports / Issue 1/2024
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-024-04415-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Conjoined lumbosacral nerve root: a case report

Abstract

Background

Case presentation

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

‘Skip’ osteoporosis vertebral compression fractures caused by electrical injury: a case report and review of the literature

Peripartal management of dichorial twin pregnancy in a bicornuate bicollis uterus: a case report and review of the literature

The impact of manual vacuum-assisted closure technique in wound healing: a case report

Superior mesenteric vein thrombosis due to COVID-19 vaccination: a case report

An unusual case of severe asphyxia with the fetal position unexpectedly inverted in a malformed uterus: a case report

Molecular diagnosis of Taenia saginata from two patients in Palestine: two case reports