Biomaterial Database

Clinical features of conjoined lumbosacral nerve roots versus lumbar intervertebral disc herniations. 2010

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

Sunnybrook Health Science Centre, 2075 Bayview Avenue, Suite MG361, Toronto, ON, M4N 3M5, Canada.

Unidentified nerve root anomalies, conjoined nerve root (CNR) being the most common, may account for some failed spinal surgical procedures as well as intraoperative neural injury. Previous studies have failed to clinically discern CNR from herniated discs and found their surgical outcomes as being inferior. A comparative study of CNR and disc herniations was undertaken. Between 2002 and 2008, 16 consecutive patients were diagnosed intraoperatively with CNR. These patients were matched 1:2 with 32 patients diagnosed with intervertebral disc herniations. Matching was done according to age (within 5 years), gender and level of pathology. Surgery for patients with CNR or disc herniations consisted of routine microsurgical techniques with microdiscectomy, hemilaminotomy, hemilaminectomy and foraminotomy as indicated. Outcomes were measured using the Oswestry Disability Index and the Short Form-36 Questionnaire. Clinical presentation, imaging studies and surgical outcomes were compared between the groups. Conjoined nerve root's incidence in this study was 5.8% of microdiscectomies performed. The S1 nerve root was mainly involved (69%), followed by L5 (31%). Patients with CNR tended to present with nerve root claudication (44%) compared to the radiculopathy accompanying disc herniations (75%). Neurologic deficit was less prevalent among patients with CNR. Nerve root tension tests were not helpful in distinguishing between the etiologies. Radiologist's suspicion threshold for nerve root anomalies was low (0%) and no coronal reconstructions were obtained. The surgeon's clinical suspicion accurately predicted 40% of the CNRs. Surgical outcomes did not differ between the cohorts regarding the rate of postoperative improvement, but CNR patients showed a trend toward having mildly worse long-term outcomes. Suspecting CNRs preoperatively is beneficial for appropriate treatment and avoiding the risk of intraoperative neural injury. With nerve root claudication and imaging suggestive of a "disc herniation", the surgeon should be alert to the differential diagnosis of a CNR. Treatment is directed at obtaining adequate decompression by laminectomy and foraminotomy to relieve the lateral recess stenosis. Outcomes can be expected to be similar to routine disc herniations.

UI	MeSH Term	Description	Entries
D007405	Intervertebral Disc Displacement	An INTERVERTEBRAL DISC in which the NUCLEUS PULPOSUS has protruded through surrounding ANNULUS FIBROSUS. This occurs most frequently in the lower lumbar region.	Disc Herniation,Disc Protrusion,Disc, Herniated,Disk Herniation,Disk Protrusion,Disk, Herniated,Intervertebral Disc Herniation,Intervertebral Disc Protrusion,Intervertebral Disk Displacement,Intervertebral Disk Herniation,Intervertebral Disk Protrusion,Prolapsed Disk,Protruded Disc,Protruded Disk,Slipped Disk,Disk Prolapse,Herniated Disc,Herniated Disk,Prolapsed Disc,Slipped Disc,Disc Displacement, Intervertebral,Disc Herniations,Disc Protrusion, Intervertebral,Disc Protrusions,Disc Protrusions, Intervertebral,Disc, Prolapsed,Disc, Protruded,Disc, Slipped,Discs, Protruded,Disk Displacement, Intervertebral,Disk Herniations,Disk Prolapses,Disk Protrusion, Intervertebral,Disk Protrusions,Disk, Prolapsed,Disk, Protruded,Disk, Slipped,Herniated Discs,Herniated Disks,Herniation, Disc,Herniation, Disk,Herniation, Intervertebral Disc,Herniation, Intervertebral Disk,Intervertebral Disc Displacements,Intervertebral Disc Herniations,Intervertebral Disc Protrusions,Intervertebral Disk Displacements,Intervertebral Disk Herniations,Intervertebral Disk Protrusions,Prolapse, Disk,Prolapsed Discs,Prolapsed Disks,Prolapses, Disk,Protruded Discs,Protruded Disks,Protrusion, Disc,Protrusion, Disk,Protrusion, Intervertebral Disc,Protrusion, Intervertebral Disk,Protrusions, Intervertebral Disk,Slipped Discs,Slipped Disks
D007796	Laminectomy	A surgical procedure that entails removing all (laminectomy) or part (laminotomy) of selected vertebral lamina to relieve pressure on the SPINAL CORD and/or SPINAL NERVE ROOTS. Vertebral lamina is the thin flattened posterior wall of vertebral arch that forms the vertebral foramen through which pass the spinal cord and nerve roots.	Laminotomy,Laminectomies,Laminotomies
D008159	Lumbar Vertebrae	VERTEBRAE in the region of the lower BACK below the THORACIC VERTEBRAE and above the SACRAL VERTEBRAE.	Vertebrae, Lumbar
D008297	Male		Males
D011795	Surveys and Questionnaires	Collections of data obtained from voluntary subjects. The information usually takes the form of answers to questions, or suggestions.	Community Survey,Nonrespondent,Questionnaire,Questionnaires,Respondent,Survey,Survey Method,Survey Methods,Surveys,Baseline Survey,Community Surveys,Methodology, Survey,Nonrespondents,Questionnaire Design,Randomized Response Technique,Repeated Rounds of Survey,Respondents,Survey Methodology,Baseline Surveys,Design, Questionnaire,Designs, Questionnaire,Methods, Survey,Questionnaire Designs,Questionnaires and Surveys,Randomized Response Techniques,Response Technique, Randomized,Response Techniques, Randomized,Survey, Baseline,Survey, Community,Surveys, Baseline,Surveys, Community,Techniques, Randomized Response
D011843	Radiculopathy	Disease involving a spinal nerve root (see SPINAL NERVE ROOTS) which may result from compression related to INTERVERTEBRAL DISK DISPLACEMENT; SPINAL CORD INJURIES; SPINAL DISEASES; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root.	Nerve Root Avulsion,Nerve Root Compression,Nerve Root Disorder,Radiculitis,Nerve Root Inflammation,Radiculopathy, Cervical,Avulsion, Nerve Root,Avulsions, Nerve Root,Cervical Radiculopathies,Cervical Radiculopathy,Compression, Nerve Root,Compressions, Nerve Root,Inflammation, Nerve Root,Nerve Root Avulsions,Nerve Root Compressions,Nerve Root Disorders,Nerve Root Inflammations,Radiculitides,Radiculopathies,Radiculopathies, Cervical
D004185	Disability Evaluation	Determination of the degree of a physical, mental, or emotional handicap. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for Social Security and workmen's compensation benefits.	Disability Evaluations,Evaluation, Disability,Evaluations, Disability
D005260	Female		Females
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D016009	Chi-Square Distribution	A distribution in which a variable is distributed like the sum of the squares of any given independent random variable, each of which has a normal distribution with mean of zero and variance of one. The chi-square test is a statistical test based on comparison of a test statistic to a chi-square distribution. The oldest of these tests are used to detect whether two or more population distributions differ from one another.	Chi-Square Test,Chi Square Distribution,Chi Square Test,Chi-Square Distributions,Chi-Square Tests,Distribution, Chi-Square,Distributions, Chi-Square,Test, Chi-Square,Tests, Chi-Square

Related Publications

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

Conjoined lumbosacral nerve roots.

January 1993, Acta neurochirurgica,

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

[Conjoined lumbosacral nerve roots].

January 1984, Duodecim; laaketieteellinen aikakauskirja,

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

Microendoscopic decompression of conjoined lumbosacral nerve roots.

March 2022, BMJ case reports,

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

Clinical features and treatments of upper lumbar disc herniations.

August 2010, Journal of Korean Neurosurgical Society,

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

Metrizamide myelography in conjoined lumbosacral nerve roots.

March 1983, Journal of the Canadian Association of Radiologists,

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

Conjoined lumbosacral nerve roots: current aspects of diagnosis.

March 2004, European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society,

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

The clinical significance of gadolinium enhancement of lumbar disc herniations and nerve roots on preoperative MRI.

December 1998, Neuroradiology,

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

THE PLACE OF NEUROSURGERY IN LUMBAR INTERVERTEBRAL DISC HERNIATIONS.

November 1964, Neurochirurgia,

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

Intraoperative conjoined lumbosacral nerve roots associated with spondylolisthesis.

July 2013, European journal of orthopaedic surgery & traumatology : orthopedie traumatologie,

R Lotan, and A Al-Rashdi, and A Yee, and J Finkelstein

Conjoined lumbosacral nerve roots. Diagnosis with metrizamide myelography.

August 1983, Surgical neurology,