Three Cases of Neuropathic Pain Induced by Lumbar Disc Herniation Accompanied Conjoined Nerve Root Treated with Different Surgical Methods

<p>  We present three cases of L5-S1 disc herniation accompanied by the conjoined nerve root (CNR) anomaly that affects the S1 nerve root. All patients in these cases are female and they experienced radiating pain within the L5 and S1 dermatomes. Detailed MRI scans confirmed the presence of lumbar disc herniation (LDH) specifically at the L5-S1 level. The surgical approach undertaken included a partial hemilaminectomy and facetectomy at the L5-S1 level. While two of the cases exclusively underwent decompression procedures, the third case involved not only decompression but also the extraction of the herniated disc material. Although two patients found complete relief from their pain, one patient continued to experience pain even after the surgical intervention. Subsequently, the latter patient underwent an additional procedure involving spinal cord stimulation (SCS), resulting in remarkable improvement in their symptoms. These three cases serve to underscore the significance of considering the presence of CNR, particularly in situations where even minor instances of LDH result in severe symptoms affecting the lower extremities. In addition, this consideration is important when symptoms cannot be directly attributed to a single nerve root. It is worth noting that surgical decompression alone may not always be sufficient for pain relief in patients having CNR. This case highlights the potential of SCS as an effective solution for patients with CNR suffering from LDH. Hence, the incorporation of SCS should be contemplated as an adjunct treatment for CNR, especially when standard decompression procedures fall short of providing the desired relief. This study effectively demonstrates strategic approaches to address CNR-associated symptoms evident in cases of L5-S1 disc herniation. In addition, it emphasizes the necessity of tailoring treatment strategies to suit individual patients, thereby optimizing the potential outcomes.</p>