Extraforaminal Minimally Invasive Lumbar Conjoined Nerve Root Decompression And Segment Fusion: Surgical Technique, Case Report And Literature Review

Authors

Manuel Rodríguez García, Orthopedist, minimally invasive spine surgery, Spine Clinic, Neurological Center, ABC Campus Santa Fe Medical Center, Mexico City
José Antonio Soriano Sánchez, Neurosurgeon, minimally spine invasive surgery, Spine Clinic, Neurological Center, ABC Campus Santa Fe Medical Center, Mexico City
Sergio Soriano Solis, Orthopedist, minimally invasive spine surgery, Spine Clinic, Neurological Center, ABC Campus Santa Fe Medical Center, Mexico City
Oscar Sánchez Escandón, Neurologist, neurophysiology, Spine Clinic, Neurological Center, ABC Campus Santa Fe Medical Center, Mexico City
Iris Tatiana Montes González, Neurosurgeon, fellow minimally invasive surgery, Spine Clinic, Neurological Center, ABC Campus Santa Fe Medical Center, Mexico City. Clinica Imbanaco, Cali. Clínica Cristo Rey, Cali. ColombiaFollow

Corresponding Author

Iris Tatiana Montes González, Neurosurgeon, Fellow Minimally invasive surgery, Spine Clinic, Neurological Center, ABC Campus Santa Fe Medical Center, Mexico City. Clínica Imbanaco, Cali. Clinica Sebastian de Belalcazar, Cali. Colombia. Clínica Cristo Rey, Cali. Colombia. E-mail: iris.montes787@gmail.com, Phone: +52 5616072196. +573153006988 ORCID https://orcid.org/0000-0001-9459-5647

Document Type

Case Report

Abstract

INTRODUCTION

Associated or conjoined nerve roots are an embryological anomaly presented primarily as bifid nerve roots arising from the dura. They are susceptible to trauma with radicular symptoms and even neurological deterioration of patients presenting them, due to space they occupy and adhesions to adjacent structures. We report a case treat with a minimally invasive technique.

CASE REPORT

A 68-year-old woman with lumbar and radicular pain in the right lower limb, with findings of L4-L5 instability and L4-L5, L5-S1 degenerative disc changes on imaging studies with bilateral L5 and S1 radiculopathy predominantly on the right side on preoperatory neurophysiological studies. A conjoined nerve root at the L5-S1 neuro-foramen on the right side was documented in an MRI study and during the operation. A minimally invasive extraforaminal lumbar interbody fusion (MI-ELIF) was performed, with right extraforaminal L5-S1 decompression; both nerve roots were mapped with monopolar stimulation, obtaining neurophysiological response and full post-decompression recovery. Preoperative, intraoperative, and postoperative figures are presented.

CONCLUSIONS

Identification of nerve root anatomic variants, such as conjoined nerve roots, is mandatory to avoid neurological injury to the patient. Suppose a conjoined root is documented during the posterior approach for interbody fusion through the foramen or extraforaminal. In that case, we suggest not forcing the cage through the joint root space but instead using the contralateral space and directly decompressing the conjoined root.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

García, Manuel Rodríguez; Soriano Sánchez, José Antonio; Solis, Sergio Soriano; Escandón, Oscar Sánchez; and Montes González, Iris Tatiana (2024) "Extraforaminal Minimally Invasive Lumbar Conjoined Nerve Root Decompression And Segment Fusion: Surgical Technique, Case Report And Literature Review," Archives of Neurosurgery: Vol. 2: Iss. 1, Article 10.
DOI: https://doi.org/10.71119/2992-8478.1043
Available at: https://www.ansjournal.org/home/vol2/iss1/10