Turkish Neurosurgery
Lumbosacral conjoined root anomaly. Anatomical considerations of exiting angles and root thickness, results of 21 patients
Can Halil1, Kırcelli Atilla2, Kavadar Gülis3, Civelek Erdinç1, Cansever Tufan2, Aydoseli Aydın4, Önal Mehmet Bülent5, Yılmaz Cem2
1Private Medicine Hospital, Neurosurgery Clinic, Istanbul,
2Başkent University, Department of Neurosurgery, Ankara,
3Private Medicine Hospital, Physical Medicine and Rehabilitation Clinic, Istanbul,
4Istanbul University, Istanbul School of Medicine, Department of Neurosurgery, Istanbul,
5Private Dünya Hospital, Neurosurgery Clinic, Batman,
DOI: 10.5137/1019-5149.JTN.16490-15.1

Aim:Conjoined nerve roots (CNR) can be damaged during lumbar disc surgery and lead to neuropathic pain due to excessive retraction. The purpose of this study was to investigate the factors that facilitate the identification of CNRs which can lead to the loss of fragments in the secondary axilla, nerve root injury or unpleasant surprises during lumbar disc surgery. Accordingly, we aimed to measure the thicknesses and exit angles of the nerve roots close to the pedicle, to obtain scientific data regarding rare double roots.Material and Methods:A total of 612 lumbar disc cases operated on in our hospital between 2012 and 2014 were reviewed retrospectively and 21 cases of CNRs were presented in this series.Results:The mean nerve root thickness was 1.92 ± 0.45 for medially located roots and 3.33 ± 0.95 for laterally located roots. The comparison of medially located roots vs laterally located roots revealed a significant difference in mean values (p<0.0001). The mean exit angle was 12.29± 4.89 for medially located roots, and 22.11 ± 5.42 for laterally located roots (p<0.0001). In addition, the exit angles of the medially and laterally located roots increased as going down to caudal levels, (p=0.005, p=0.042). Conclusion:CNRs are congenital anomalies that are usually diagnosed during surgical procedure and affect the success of discectomy. The presence of a more medially located or thinner root during surgical exploration and the absence of the fragment in the axilla in extruded or sequestered discs usually indicate a conjoined nerve root closer to the pedicle.

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