Nerve root anomalies detected intra-operatively technical nuances towards achieving a successful surgical outcome: our experience of three case reports at a tertiary level centre

Abstract

3 patients in one year period.

Extradural Characteristics of the Origins of Lumbosacral Nerve Roots

“…One hypothesis claims the defect of the nerve roots migration during the embryonic development that would to some extent explain why anomalies are usually unilateral. 2 Anomalies of the lumbosacral segments range between 5% and 10%. These observations point to a possible etiological relationship between spinal anomalies and nerve root anomalies.…”

“…Incidence ranges from 1.3% found during surgery 4 to 2 to 6.7% detected through imaging methods before surgery 3,9-11 and from 8.5% to 30% during studies of cadavers. 12 Most frequently they are reported to be unilateral, usually at level L5-S1, [1][2][3]5,6 and can be a cause of operative failure. 2,13 Of the 200,000 patients operated on annually for herniated intervertebral disks in the United States, 33% were unsuccessful operations.…”

“…12 Most frequently they are reported to be unilateral, usually at level L5-S1, [1][2][3]5,6 and can be a cause of operative failure. 2,13 Of the 200,000 patients operated on annually for herniated intervertebral disks in the United States, 33% were unsuccessful operations. 3,14,15 Freguia et al 16 recently reported one case of unilateral lumbar radiculopathy misdiagnosed with a lumbosacral disk herniation on magnetic resonance imaging (MRI).…”

“…16 Dhar et al also reported three cases of conjoined nerve root (L4-L5, L5-S1, all of them on the left side) that were not revealed on preoperative MRI, and the neurosurgeons were obliged to change their actual management plan. 2 Hence knowing more about the importance of different types of nerve roots anomalies will increase the number of successful operations. 1,17 Preoperative and perioperative evaluations should be thorough to prevent nerve injury during surgery.…”