STUDY DESIGN: Retrospective cross-sectional study of cases with conjoined lumbar nerve root anomalies. OBJECTIVE: To provide a description of presenting symptoms and clinical signs of conjoined nerve roots. SUMMARY OF BACKGROUND DATA: Nerve root anomalies are frequently underrecognized on advanced imaging studies and are also underappreciated and underreported when encountered surgically. METHODS: In this retrospective cross-sectional study, we report the intraoperative identification of 22 cases of conjoined nerve root anomaly, encountered within a period of 11 years. All cases underwent hemilaminectomy in addition to medial facetectomy and pediculectomy. All patients were followed for a mean duration of 53+/-8.2 months (range, 2 to 108 mo). RESULTS: Twenty-two patients had conjoined nerve root anomaly (mean age at diagnosis=47.7+/-5.1). They included 11 cases of L5-S1, 10 cases of L4-L5, and 1 of S1-S2. Twelve patients (54.5%) had symptoms in 2 territories. Straight leg raising sign and crossed straight leg raising were positive in 14 (63.6%) and 7 (31.8%) patients, respectively. All patients returned to work within 2 months after surgery. The signs and symptoms in only 7 cases (31.8%) could be explained by the underlying pathology (disc herniation) alone. In the remaining 68%, the conjoined roots have probably contributed to the incompatible signs and symptoms. CONCLUSIONS: Twin dermatomal involvements, in addition to a negative Lasègue sign, are clues to the diagnosis of a probable conjoined nerve root anomaly. Extension of routine hemilaminectomy to a facetectomy and partial pediculectomy leads to a favorable outcome.
STUDY DESIGN: Retrospective cross-sectional study of cases with conjoined lumbar nerve root anomalies. OBJECTIVE: To provide a description of presenting symptoms and clinical signs of conjoined nerve roots. SUMMARY OF BACKGROUND DATA: Nerve root anomalies are frequently underrecognized on advanced imaging studies and are also underappreciated and underreported when encountered surgically. METHODS: In this retrospective cross-sectional study, we report the intraoperative identification of 22 cases of conjoined nerve root anomaly, encountered within a period of 11 years. All cases underwent hemilaminectomy in addition to medial facetectomy and pediculectomy. All patients were followed for a mean duration of 53+/-8.2 months (range, 2 to 108 mo). RESULTS: Twenty-two patients had conjoined nerve root anomaly (mean age at diagnosis=47.7+/-5.1). They included 11 cases of L5-S1, 10 cases of L4-L5, and 1 of S1-S2. Twelve patients (54.5%) had symptoms in 2 territories. Straight leg raising sign and crossed straight leg raising were positive in 14 (63.6%) and 7 (31.8%) patients, respectively. All patients returned to work within 2 months after surgery. The signs and symptoms in only 7 cases (31.8%) could be explained by the underlying pathology (disc herniation) alone. In the remaining 68%, the conjoined roots have probably contributed to the incompatible signs and symptoms. CONCLUSIONS: Twin dermatomal involvements, in addition to a negative Lasègue sign, are clues to the diagnosis of a probable conjoined nerve root anomaly. Extension of routine hemilaminectomy to a facetectomy and partial pediculectomy leads to a favorable outcome.
Authors: Cameron K Schmidt; Tarush Rustagi; Fernando Alonso; Marios Loukas; Jens R Chapman; Rod J Oskouian; R Shane Tubbs Journal: Childs Nerv Syst Date: 2017-06-16 Impact factor: 1.475