An Amendment to the Neidre and Macnab Classification System for Lumbosacral Nerve Root Anomaly and Its Implication in Percutaneous Endoscopic Lumbar Discectomy.
World Neurosurg. 2017 Dec 09;:
Authors: Yu C, Zhengqi C, Xiuchun Y
BACKGROUND: Lumbar disc herniation complicated with nerve root anomaly presents great challenges to diagnosis and treatment, improper selection of surgical procedures may cause inferior outcomes and neurological injury.
CASE DESCRIPTION: A 66-year old male presented with low back pain and radicular symptoms involving bilateral L-5 and S-1 nerve roots. Instead of percutaneous endoscopic lumbar discectomy, aggressive decompression was carried out due to deviation between examination and imaging findings. Surgical detection disclosed a confluent nerve root comprising two adjacent contributions that arise from the thecal sac exits from the left L5/S1 foramen, in the absence of the root otherwise exiting via the caudal foramen. We found the overwhelming left radicular symptoms were attributable to compression on this swelling anomalous root by narrowed L5/S1 root cannula, aggressive decompression and distraction of the intervertebral space successfully released the nerve root. Twenty months postoperatively, he experienced evident relief of the radicular symptoms and improvement of the muscle strength with no complication.
CONCLUSIONS: Lumbosacral nerve root anomaly should be remembered and ruled out before selecting surgical methods, inappropriate procedures could not alleviate the symptoms associated with the anomalous roots and may expose such patients to risks of neural injury. In clinical practice, surgeons should select percutaneous endoscopic lumbar discectomy with caution, and stop the procedure instantly when unexplainable radicular irritation is evoked.
PMID: 29233749 [PubMed – as supplied by publisher]