Nerve root anomaly as a cause of unexpected outcomes of epidural steroid injections in lumbar radiculopathy: A case report

被引:0
作者
Shin, Dong Jae [1 ]
Lee, Yeon Soo [2 ]
Choi, Eunseok [3 ]
Yi, Jin-Seok [4 ]
机构
[1] Catholic Univ Korea, Coll Med, Dept Rehabil Med, Seoul St Marys Hosp, Seoul, South Korea
[2] Catholic Univ Korea, Coll Med, Dept Radiol, Daejeon St Marys Hosp, 64 Daeheung Ro, Daejeon 34943, South Korea
[3] Catholic Univ Korea, Coll Med, Dept Rehabil Med, Daejeon St Marys Hosp, Daejeon, South Korea
[4] Catholic Univ Korea, Coll Med, Dept Neurosurg, Daejeon St Marys Hosp, Daejeon, South Korea
关键词
Nerve root anomaly; conjoined nerve root; epidural injections; low back pain; radiculopathy; ELECTROMYOGRAPHY; IDENTIFICATION;
D O I
10.3233/BMR-210226
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
BACKGROUND: Spinal nerve root anomaly is a rare feature that can result in unexpected outcomes in epidural steroid injections or surgical procedures. Preoperative diagnostic tools for root anomalies are limited, as they are usually found intraoperatively. OBJECTIVE: This case report aims to propose an effective diagnostic process for nerve root anomalies by introducing clinical manifestations, electrodiagnostic findings, and sophisticated imaging techniques such as coronal view magnetic resonance imaging (MRI) of the lumbosacral spine. CASE DESCRIPTION: A 43-year-old female complained of low back pain with radicular pain to the lower extremities. Based on physical examination, electrodiagnosis, and imaging studies, right L5 radiculopathy was diagnosed. Repetitive image-guided epidural steroid injections presented unsuccessful outcomes. She was then referred to a neurosurgeon for surgical decompression, which resulted in significant improvement in her radicular pain. A nerve root anomaly was found intraoperatively, and the coronal images of postoperative MRI depicted the conjoined nerve root of the lumbar spine. CONCLUSION: When proper image-guided spinal interventions for discogenic radicular pain are not effective, a clinician should be advised to consider the possibility of anatomical variation, including nerve root anomalies. Early diagnosis of nerve root anomalies by utilizing multiple diagnostic tools, especially coronal MRI, can aid in preoperative diagnosis and proper clinical decisions for symptom management.
引用
收藏
页码:971 / 976
页数:6
相关论文
共 22 条
[1]  
Aota Y, 1997, J SPINAL DISORD, V10, P167
[2]  
Artico M, 2006, NEUROCIRUGIA, V17, P54
[3]   Nerve root anomalies: implications for transforaminal lumbar interbody fusion surgery and a review of the Neidre and Macnab classification system [J].
Burke, Shane M. ;
Safain, Mina G. ;
Kryzanski, James ;
Riesenburger, Ron I. .
NEUROSURGICAL FOCUS, 2013, 35 (02)
[4]   UTILITY OF ELECTRODIAGNOSTIC TESTING IN EVALUATING PATIENTS WITH LUMBOSACRAL RADICULOPATHY: AN EVIDENCE-BASED REVIEW [J].
Cho, S. Charles ;
Ferrante, Mark A. ;
Levin, Kerry H. ;
Harmon, Robert L. ;
So, Yuen T. .
MUSCLE & NERVE, 2010, 42 (02) :276-282
[5]   The use of electromyography to predict functional outcome following transforaminal epidural spinal injections for lumbar radiculopathy [J].
Fish, David E. ;
Shirazi, Eli P. ;
Pham, Quynh .
JOURNAL OF PAIN, 2008, 9 (01) :64-70
[6]   Morphometric analysis of the lumbosacral nerve roots and dorsal root ganglia by magnetic resonance imaging [J].
Hasegawa, T ;
Mikawa, Y ;
Watanabe, R ;
An, HS .
SPINE, 1996, 21 (09) :1005-1009
[7]   Usefulness of Oblique Lumbar Magnetic Resonance Imaging for Nerve Root Anomalies and Extraforaminal Entrapment Lesions [J].
Heo, Dong Hwa ;
Kim, Seok Woo ;
Chang, Hsien-Hao ;
Park, Choon-Keun .
ASIAN SPINE JOURNAL, 2018, 12 (03) :423-427
[8]  
Jokhi Vispi H, 2015, J Orthop Case Rep, V5, P14, DOI 10.13107/jocr.2250-0685.334
[9]   Conjoined lumbosacral nerve roots compromised by disk herniation: sagittal shoulder sign for the preoperative diagnosis [J].
Kang, Chang Ho ;
Shin, Myung Jin ;
Kim, Sung Moon ;
Lee, Sang Hoon ;
Kim, Hee Kyung ;
Ryu, Jeong Ah ;
Lee, Choon-Sung ;
Kim, Sam Soo .
SKELETAL RADIOLOGY, 2008, 37 (03) :225-231
[10]   Polysegmental innervation of the medial paraspinal lumbar muscles [J].
Kottlors, Michael ;
Glocker, Franz Xaver .
EUROPEAN SPINE JOURNAL, 2008, 17 (02) :300-306