Cervical Conjoined Nerve Root During Posterior Percutaneous Endoscopic Cervical Diskectomy
Mei-Cheng Hsiao1, Kai-Chen Chung1, Hsi-Kai Tsou2
1Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
World Neurosurgery
|September 29, 2023
Summary
A rare cervical conjoined nerve root was unexpectedly discovered during surgery for cervical radiculopathy. This case highlights the challenges and risks associated with treating cervical radiculopathy when unexpected nerve root variations occur.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Anatomy
Background:
- Cervical conjoined nerve root is a rare anatomical variation.
- Preoperative diagnosis using medical imaging like MRI and CT is often inaccurate.
- Surgical treatment for cervical radiculopathy with root anomalies presents significant challenges.
Observation:
- A 41-year-old woman presented with persistent neck and bilateral shoulder pain, upper back tightness, and left upper limb numbness.
- Radiographs and MRI revealed retrolisthesis at C5-C6 and cervical disk herniation with severe neuroforaminal narrowing at C5-C6 and C6-C7.
- A posterior percutaneous endoscopic cervical diskectomy was performed, during which a left-sided conjoined nerve root at C6-C7 was identified.
Findings:
- The patient experienced significant relief from pain and numbness post-surgery, with VAS scores reducing from 4/8 to 0/0 and Neck Disability Index from 26 to 1.
- A slight dural tear occurred during decompression without nerve root exposure or CSF leakage.
- This case underscores the potential for iatrogenic nerve root injury during decompression surgery when unexpected anatomical variations are encountered.
Implications:
- Posterior percutaneous endoscopic cervical diskectomy is effective for cervical disk herniation, offering benefits like minimal invasiveness and faster recovery.
- The posterior surgical approach may provide superior visualization of nerve root variants, particularly in endoscopic procedures.
- Awareness of rare anatomical variations like conjoined nerve roots is crucial for neurosurgeons to minimize operative risks and ensure patient safety.
