Department of Orthopedic Surgery, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan.
Department of Radiology, Tonami General Hospital, 1-61 Shintomi-Cho, Tonami City, Toyama, 939-1395, Japan.
J Med Case Rep. 2024 Mar 7;18(1):91. doi: 10.1186/s13256-024-04415-4.
In patients with conjoined nerve roots, hemilaminectomy with sufficient exposure of the intervertebral foramen or lateral recess is required to prevent destabilization and ensure correct mobility of the lumbosacral spine. To the best of our knowledge, no case reports have detailed the long-term course of conjoined nerve roots after surgery.
We report the case of a 51-year-old Japanese man with a conjoined nerve root. The main symptoms were acute low back pain, radiating pain, and right leg muscle weakness. Partial laminectomy was performed with adequate exposure to the conjoined nerve root. The symptoms completely resolved immediately after surgery. However, the same symptoms recurred 7 years postoperatively. The nerve root was compressed because of foraminal stenosis resulting from L5-S disc degeneration. L5-S transforaminal lumbar interbody fusion was performed on the contralateral side because of an immobile conjoined nerve root. At 44 months after the second surgery, the patient had no low back pain or radiating pain, and the muscle weakness in the right leg had improved.
This is the first report of the long-term course of conjoined nerve root after partial laminectomy. When foraminal stenosis occurs after partial laminectomy, transforaminal lumbar interbody fusion from the contralateral side may be required because of an immobile conjoined nerve root.
在神经根融合的患者中，需要进行半椎板切除术以充分暴露椎间孔或侧隐窝，以防止失稳并确保腰骶脊柱的正确活动度。据我们所知，尚无病例报告详细描述神经根融合术后的长期病程。
我们报告了一例 51 岁的日本男性神经根融合病例。主要症状为急性腰痛、放射痛和右下肢肌无力。进行了部分椎板切除术，以充分暴露融合神经根。手术后症状立即完全缓解。然而，7 年后相同的症状再次出现。由于 L5-S 椎间盘退变导致椎间孔狭窄，神经根受压。由于融合神经根活动受限，对侧行 L5-S 经椎间孔腰椎体间融合术。第二次手术后 44 个月，患者无腰痛或放射痛，右下肢肌无力改善。
这是首例部分椎板切除术后融合神经根长期病程的报告。部分椎板切除术后发生椎间孔狭窄时，由于融合神经根活动受限，可能需要从对侧行经椎间孔腰椎体间融合术。
