L4 Transpedicular Nerve Root Anomaly: The First Non-Syndromic Case Report

Anatomical variations of lumbar nerve roots are rare, and transpedicular root courses are extremely uncommon. We present the first nonsyndromic and incidentally detected case of an L4 transpedicular nerve root anomaly. A 45-year-old woman presented with right leg pain corresponding to L5–S1 radiculopathy. MRI and CT imaging revealed a right paracentral L5–S1 disk herniation, as well as an incidental right L4 nerve root passing transversely through the L4 pedicle. The patient underwent an L5–S1 diskectomy, resulting in complete resolution of symptoms and no neurological deficit. Although asymptomatic, such an anatomical variation has significant surgical implications. Detailed preoperative imaging evaluation of pedicle morphology is essential to prevent iatrogenic injury during spinal instrumentation.

Spinal nerve roots Lumbar vertebrae Anatomic variation