Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA.
Brigham and Women's Hospital, Boston, Massachusetts, USA.
BMJ Case Rep. 2022 Mar 16;15(3):e248680. doi: 10.1136/bcr-2021-248680.
Nerve root morphological variability is often incompletely appreciated on preoperative imaging and can complicate intraoperative decision-making. This case demonstrates the utility of spinal endoscopy in the visualisation and manipulation of conjoined nerve roots and includes procedural images to promote better understanding and awareness of this anatomical anomaly. A woman in her 50s presented with 1 year of progressive left S1 radiculopathy refractory to non-operative modalities. History and examination were notable for S1 dermatomal paresthesias, positive ipsilateral straight leg raise and grade 4/5 gastrocnemius strength. MRI demonstrated an L5-S1 left paracentral disc herniation causing severe lateral recess stenosis. Endoscopic decompression revealed conjoined lumbosacral nerve roots. Laminotomies and discectomy provided circumferential decompression. The patient experienced immediate and sustained relief of her preoperative radiculopathy as manifested in patient-reported outcome measures. Evolving endoscopic spine platforms provide novel visualisation of nerve root anomalies yielding new insight on safe and effective decompressive techniques.
神经根形态学的变异性在术前影像学上常常不能完全被认识到，并且可能使手术中的决策复杂化。本病例展示了脊柱内镜在观察和操作联合神经根方面的效用，并包括了手术过程的图像，以促进对这种解剖学异常的更好理解和认识。一名 50 多岁的女性因进行性左侧 S1 神经根病变而就诊，该病变对非手术治疗无效，病史和检查提示 S1 皮节感觉异常，同侧直腿抬高试验阳性，腓肠肌肌力 4/5 级。MRI 显示 L5-S1 左侧旁中央椎间盘突出导致严重的外侧隐窝狭窄。内镜减压显示联合的腰骶神经根。椎板切开术和椎间盘切除术提供了环形减压。患者在术前神经根病变的患者报告结局测量中表现出即刻和持续的缓解。不断发展的内镜脊柱平台提供了神经根异常的新的可视化，为安全有效的减压技术提供了新的见解。
