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Takagi Y, Yamada H, Ebara H, Hayashi H, Inatani H, Toyooka K, Mori A, Kitano Y, Ryu Y, Nakanami A, Yahata T, Tsuchiya H. Conjoined lumbosacral nerve root: a case report. J Med Case Rep 2024; 18:91. [PMID: 38448995 PMCID: PMC10918913 DOI: 10.1186/s13256-024-04415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/26/2024] [Indexed: 03/08/2024] Open
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.
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Affiliation(s)
- Yasutaka Takagi
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan.
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Hidehumi Ebara
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Hiroyuki Hayashi
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Hiroyuki Inatani
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Kazu Toyooka
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Akari Mori
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Yoshiyuki Kitano
- Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Yasuji Ryu
- Department of Radiology, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Aki Nakanami
- Department of Rehabilitation Medicine, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan
| | - Tetsutaro Yahata
- Department of Rehabilitation Medicine, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa City, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-Machi, Kanazawa City, Ishikawa, 920-8641, Japan
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Sharma A, Singh V, Agrawal R, Mangale N, Deepak P, Savla J, Jaiswal A. Conjoint Nerve Root an Intraoperative Challenge in Minimally Invasive Tubular Discectomy. Asian Spine J 2020; 15:545-549. [PMID: 33189107 PMCID: PMC8377216 DOI: 10.31616/asj.2020.0250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022] Open
Abstract
Conjoint nerve root (CNR) is an embryological nerve root anomaly that mainly involves the lumbosacral region. The presence of CNR during tubular discectomy raises the chances of failure in spinal surgery and the risk of neural injuries. Tubular discectomy can be challenging in the presence of CNR owing to limited visualization. Here, we present a technical note on two cases of L5–S1 disc prolapse in the presence of conjoint S1 nerve root that was operated via a minimally invasive tubular approach. Any intraoperative suspicion of CNR while using the tubular approach should prompt the surgeon to perform a thorough tubular decompression prior to nerve root retraction. In patients with a large disc, disc should be approached via the axilla because the axillary area between the dura and the medial boarder of the root is very easy to approach in the presence of CNR. Safe performance of tubular discectomy is possible even in the presence of CNR in the lumbar spine.
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Affiliation(s)
- Ayush Sharma
- Department of Orthopedic and Spine Surgery, Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | - Vijay Singh
- Department of Orthopedic and Spine Surgery, Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | - Romit Agrawal
- Department of Orthopedic and Spine Surgery, Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | - Nilesh Mangale
- Department of Orthopedic and Spine Surgery, Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | - Priyank Deepak
- Department of Orthopedic and Spine Surgery, Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | - Jeet Savla
- Department of Orthopedic and Spine Surgery, Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | - Ajay Jaiswal
- Department of Orthopedic and Spine Surgery, Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
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Schmidt CK, Rustagi T, Alonso F, Loukas M, Chapman JR, Oskouian RJ, Tubbs RS. Nerve root anomalies: making sense of a complicated literature. Childs Nerv Syst 2017. [PMID: 28623517 DOI: 10.1007/s00381-017-3457-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Nerve root anomalies (NRAs) are a set of well-described congenital irregularities for which several classification systems have been devised over the years. CONCLUSION This comprehensive review examines the anatomy and characteristics of NRAs; their surgical, radiographic, and cadaveric prevalence rates; clinical and radiographic presentations; and surgical management. In addition, the top 5 NRA classification systems are presented and related.
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Affiliation(s)
- Cameron K Schmidt
- Seattle Science Foundation, 550 17th Ave., James Tower, Suite 600, Seattle, WA, 98122, USA.
| | - Tarush Rustagi
- Swedish Neuroscience Institute, 550 17th Ave., Seattle, WA, 98122, USA
| | - Fernando Alonso
- Swedish Neuroscience Institute, 550 17th Ave., Seattle, WA, 98122, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, West Indies, Grenada
| | - Jens R Chapman
- Swedish Neuroscience Institute, 550 17th Ave., Seattle, WA, 98122, USA
| | - Rod J Oskouian
- Swedish Neuroscience Institute, 550 17th Ave., Seattle, WA, 98122, USA
| | - R Shane Tubbs
- Seattle Science Foundation, 550 17th Ave., James Tower, Suite 600, Seattle, WA, 98122, USA
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