Cervical conjoined nerve root variant: preoperative imaging and surgical conformation. Case report

Area of Science:

• Neurology
• Neurosurgery
• Anatomy

Background:

• Cervical radiculopathy often presents with symptoms like pain and weakness, typically caused by nerve root compression.
• Differential diagnosis for cervical radiculopathy includes various structural abnormalities affecting the cervical spine.
• Nerve root anomalies, while uncommon, can mimic or contribute to radicular symptoms.

Observation:

• A unique case of a cervical nerve root anomaly was observed in a patient presenting with cervical radiculopathy.
• Preoperative imaging (contrast-enhanced CT and MRI) revealed an abnormality posterior to the C-4 vertebral body, spanning the C3-4 and C4-5 neural foramina.
• Intraoperative findings identified a dural-encased structure connecting the C-4 and C-5 nerve roots within the spinal canal.

Findings:

• The identified anomaly represents the first reported instance of this specific type of cervical nerve root variation, characterized as a variant of a conjoined nerve root.
• Surgical intervention involving posterolateral exploration and decompression led to significant symptom resolution.
• The patient experienced notable relief of pain and improvement in motor strength post-surgery.

Implications:

• This case underscores the necessity of including rare cervical nerve root anomalies in the differential diagnosis for patients with cervical radiculopathy.
• Recognition of such anomalies can guide appropriate surgical planning and treatment strategies.
• Further investigation into the prevalence and clinical significance of these variations in the cervical spine is warranted.