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. 2024 Aug 26;8(9):CASE24301.
doi: 10.3171/CASE24301. Print 2024 Aug 26.

Contralateral discectomy as a novel approach for disc herniation compressing a conjoined nerve root: illustrative case

Leonidas Trakolis  1 , Athanasios K Petridis  1   2
Affiliations

Contralateral discectomy as a novel approach for disc herniation compressing a conjoined nerve root: illustrative case

Leonidas Trakolis et al. J Neurosurg Case Lessons. .

Abstract

Background: A conjoined nerve root is a rare condition with numerous variants. The diagnosis can be challenging, especially when the condition coexists with other pathologies. In cases where a disc herniation affects these nerve roots, any miscalculation or inexperience of the surgeon can irreversibly injure them. Numerous reports have described the dismay of surgeons during discectomy in patients with a conjoined nerve root. Many surgical techniques have been suggested but without the good results following typical discectomies.

Observations: In this case report, the authors describe a 53-year-old female patient who presented with radicular pain due to a large disc herniation at the level of L5-S1 on the left side. Intraoperatively, the authors identified a conjoined nerve root, forcing them to employ a novel approach with very good results.

Lessons: In some cases, the only possible way to remove a disc herniation is the contralateral approach, as described in this report. https://thejns.org/doi/10.3171/CASE24301.

Keywords: conjoined nerve; contralateral discectomy; disc herniation.

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Figures

FIG. 1.
FIG. 1.
Sagittal T2-weighted MRI sequence showing the 2 L5 nerve roots (red arrow).
FIG. 2.
FIG. 2.
Sagittal T2-weighted MRI sequence showing unifying of the L5 nerve root in the foramen (red arrow).
FIG. 3.
FIG. 3.
Axial T2-weighted MRI sequence showing 1 of the 2 L5 nerve roots (red arrow), whereas the other is hidden under the disc herniation.
FIG. 4.
FIG. 4.
Axial T2-weighted MRI sequence showing disc herniation between the 2 L5 roots (red arrows).
FIG. 5.
FIG. 5.
Illustration of the anatomy seen during surgery in our case. The arrows highlight the L5 nerve roots on the left side.
See this image and copyright information in PMC

References

    1. Lotan R, Al-Rashdi A, Yee A, Finkelstein J. Clinical features of conjoined lumbosacral nerve roots versus lumbar intervertebral disc herniations. Eur Spine J. 2010;19(7):1094-1098. - PMC - PubMed
    1. Trimba R, Spivak JM, Bendo JA. Conjoined nerve roots of the lumbar spine. Spine J. 2012;12(6):515-524. - PubMed
    1. Song SJ, Lee JW, Choi JY, et al. Imaging features suggestive of a conjoined nerve root on routine axial MRI. Skelet Radiol. 2008;37(2):133-138. - PubMed
    1. Haijiao W, Koti M, Smith FW, Wardlaw D. Diagnosis of lumbosacral nerve root anomalies by magnetic resonance imaging. J Spinal Disord. 2001;14(2):143-149. - PubMed
    1. Böttcher J, Petrovitch A, Sörös P, Malich A, Hussein S, Kaiser WA. Conjoined lumbosacral nerve roots: current aspects of diagnosis. Eur Spine J. 2004;13(2):147-151. - PMC - PubMed

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